Skin & Subcutaneous Tissue

{"ops":[{"insert":"Systemic sclerosis"},{"insert":"\n","attributes":{"header":1}},{"insert":"Systemic sclerosis (SS) is a rare chronic disease of unknown cause that is characterized by diffuse fibrosis, degenerative changes, and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus, lower GI tract, lungs, heart, and kidneys). It may develop as part of mixed connective tissue disease (MCTD).\r\n\r\nSS is about 4 times more common among women than men, with the highest incidence between the ages of 20 to 50. The diagnosis is clinical, with laboratory tests helping with confirmation. Specific treatment is difficult, and emphasis is often on treatment of complications.\n"},{"insert":"The fourth heart sound"},{"insert":"\n","attributes":{"header":1}},{"insert":"The fourth heart sound (S4) occurs late in diastole; this occurs when atrial contraction forces blood into a stiffened ventricle, just prior to the ventricular systole. This sound is best heard with the bell of the stethoscope, while the patient lies in the left lateral decubitus position.\r\n\r\nThe presence of a S4 indicates decreased ventricular compliance, often due to hypertrophy. Key causes include hypertensive heart disease, aortic stenosis, pulmonary hypertension, and hypertrophic cardiomyopathy.\n"}]}

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