In which of the following conditions might the intensity of the heart sounds be reduced? 1. Heart failure 2. Severe cachexia 3. Pneumothorax 4. Pleural effusion
a. 1, 3, and 4 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, and 3 only
ANS: A
Pulmonary hyperinflation, pleural effusion, pneumothorax, and obesity make identification of both S1 and S2 difficult. The intensity of S1 and S2 also decreases when the force of ventricular contraction is poor, as in heart failure, or when valvular abnormalities exist.
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