Family Nurse Practitioner Exam

What heart sounds are commonly found in a toddler with congestive heart failure?

1. S1 and S2

2. S1, S2, and S3

3. S1, S2, and S4

4. Still's murmur and S4

The correct answer is: S1, S2, and S3

In a toddler with congestive heart failure, the presence of S1, S2, and S3 heart sounds is significant. S1 and S2 are the normal heart sounds produced by the closure of the heart valves during the cardiac cycle. S3, also known as a "ventricular gallop," can be indicative of heart failure, as it suggests increased volume or pressure overload in the ventricles. In the context of congestive heart failure, the S3 sound results from rapid filling of the ventricles during early diastole, which is often a consequence of fluid overload that accompanies heart failure. Thus, when assessing a child suspected of having congestive heart failure, the presence of S1, S2, and an additional S3 sound helps to confirm the diagnosis. While S4 may sometimes be heard in older individuals with reduced ventricular compliance, it is less common in toddlers and usually reflects a different cardiac condition. Similarly, Still's murmur—often a benign finding in children—does not relate directly to heart failure but instead reflects normal physiological variations in blood flow. Therefore, the identification of S1, S2, and S3 sounds is key in diagnosing congestive heart failure in a toddler.