Question

1. The nurse is performing a cardiac assessment on a client 3 days after a myocardial infarction. Their heart sounds are normal when lying supine, but when sitting and leaning forward, the nurse auscultates a high pitched scratchy sound with a diaphragm of the stethoscope at the apex. The sound disappears on the inspiration. What does the nurse suspect?

1. Inflammation of the precordium
2. Increased cardiac output
3. Ventricular hypertrophy resulting from muscle damage
4. Another myocardial infarction

Answer 1

Answer : Inflammation of the precordium

Inflammation of the precordium cause a friction rub sound which is high pitched scratchy. It is best auscultated with the diaphragm of the stethoscope when the person sitting up and leaning forward, and is louder at the end of expiration and disappears on inspiration. Also this sound is best heard at the apex and left sternal edge of the fourth intercostal space, where the pericardium comes in close contact with the chest wall.

While increased cardiac output, ventricular hypertrophy resulting from muscle damage or another myocardial infarction do not gives rise to a high pitched scratchy friction rub sound while exhale. So option B, C and D are incorrect.