goodduck

[S&S]

1. forward decrease -> low C.O -> fatigue / exertional dyspnea -> LV failure
2. backflow -> LA pressure increase -> pulmonary HTN
3. chronic -> LV enlargement -> Atrial Fib.(intermitten or persistent)

[PE]
1. heart sound
    a. S1 diminish
    b. wide splitting S2
    c. S3
2. murmur
    a. holosystolic murmur; in apex, radiate to axilla; high pitch
    b. post. leaflet -> also in aortic area <- D/D:AS (don't radiate to carotid a.)
    c. ant. leaflet -> loud, radiate to back, top of head
    d. handgrip -> intense ; Valsalva -> decrease
3. pulse
    a. similar to bounding pulse (AR), but pulse pressure normal