Means–Lerman scratch
Means–Lerman Scratch
TheMeans–Lerman scratch is a rare cardiac auscultatory phenomenon associated with hyperdynamic circulation, particularly in the context of thyrotoxicosis. It is characterized by a scratching or rasping sound heard during auscultation of the heart, typically over the precordium.
History
The Means–Lerman scratch was first described by J. H. Means and J. Lerman in the early 20th century. Their observations were based on patients with Graves' disease, a common cause of thyrotoxicosis, who exhibited this unique auscultatory finding.
Pathophysiology
The exact mechanism of the Means–Lerman scratch is not fully understood, but it is believed to be related to the increased cardiac output and hyperdynamic state seen in conditions like thyrotoxicosis. The sound is thought to be produced by the rubbing of the pericardial surfaces or the vibration of cardiac structures due to the increased force of cardiac contractions.
Clinical Significance
The presence of a Means–Lerman scratch can be an important clinical clue in diagnosing hyperthyroid conditions. It is, however, a rare finding and not commonly encountered in routine clinical practice. When present, it should prompt further investigation into the patient's thyroid function and overall cardiovascular status.
Diagnosis
Diagnosis of the Means–Lerman scratch is primarily clinical, based on auscultation. It is important to differentiate it from other cardiac sounds such as pericardial friction rubs or murmurs. A thorough clinical examination and correlation with other signs and symptoms of thyrotoxicosis are essential.
Management
Management of the Means–Lerman scratch involves addressing the underlying cause of the hyperdynamic circulation. In cases of thyrotoxicosis, treatment may include antithyroid medications, radioactive iodine therapy, or surgical intervention. Once the underlying condition is controlled, the auscultatory finding typically resolves.
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| Physiology of the endocrine system | ||||||||
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