DOCSLIB.ORG

Significance of Symptoms.? Huchard1'thinks That Brady-Diastole" Or

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Significance of Symptoms.? Huchard1'thinks That Brady-Diastole April 6, 1895. THE HOSPITAL. Progress in Medicine. DISEASES OF THE CIRCULATORY SYSTEM. firmed by a similar examination, and believes that tbere are one occurs as above in re- (Continued from page 460, Vol. X VII.) two varieties ; (I.) thinks that gurgitation, and the other (II.) which is merely a species Significance of Symptoms.?Huchard1' " of the anacrotic with the second wave rounded brady-diastole" or prolongation of the diastole pulse and does itself in is a sign of most serious import when occurring beginning high, actually present stenosis. Even the true anacrotic is shown in cerebral hajmorrhages, comatose states, and pulse by Steell25 not to be indicative of and the arterial degenerations. The cause of inorganic always stenosis, P. bisferiens has been observed where there was no in- insufficiency of the mitral valve ia referred by to a of Mahomed's. Dombrowski13, not to dilatation of the orifice, but to competence according paper The condition of the blood in the of displacement of the papillary muscles, which prevents cyanosis congeni- disease has been various observers. closure of the valve. Romberg, however, insists that tal heart analysed by Banholtzer26 found in one case that the this is contrary to the known action of those muscles.1' haemoglobin stood at 160 cent, of normal, and the red cells at A new diagnostic sign in anaemia is announced by per in of A. Morrison-7 Verstraeten20 in the presence of a bruit de diable just 9,450,000 place 5,000.000. the were 110 below the inferior border of the liver, and about three- gives two others in which figures and 92 cent, for and quarters of a centimetre to the right of the median per cent, per hcemoglobin, the and and he line. It is produced in the inferior vena cava, and corpuscles 8,470,000 6,700,000, quotes similar from other writers. He believes occurs in anaemia, but not in hepatic cirrhosis. The instances be too to be accounted for signs of dilatation of the right ventricle are discussed the increase to great by by S tacey W ilson21. The ch ief dilatation in adolescence concentration of the blood, but that it is in a sense occurs upwards and to the left, so that the pulmonary compensatory. The corpuscles being insufficiently their functions and wear and tear valves may be under the first interspace, and the oxygenated, are individual duration is ventricle may extend to the left nipple line in the lessened, and their so number becomes second space. Some rotation of the heart takes place increased, that their total The increase occurs not at the same time, so that the apex often appears in the much greater than usual. where fourth space external to the nipple line. In later life only in congenital cases, but also in others rare case of the dilatation may extend a little to the right of the cyanosis is present. A very pulmonary sternum, as well as upwards. The signs are pulsation incompetence occurring in adult life and confirmed in second and third left interspaces and in the veins post-mortem is recorded by T. Oliver.28 The diastolic of the neck, while the apex beat is in the fourth space ; murmur was conveyed down the left of the sternum increased area of dulness; a pulmonary systolic to the apex of the right ventricle, while the pulse was murmur; accentuated second sound bruit de diable, not that of aortic regurgitation. Cyanosis, distended of were also signs tricuspid regurgitation ; and a bruit de galop. veins in the neck, and profuse epistaxis Several of these signs may be absent. noted. Another case of interest29 is one of embolic A discussion on the significance of an accentuated pneumonia, caused by endarteritis of the pulmonary second sound has been carried on by Ringer and artery, which was associated with congenital stenosis. Fear, Ewart, and others. The two former show Shingleton Smith who reports the case, remarks that that a high tension causes a loud second sound, but right endocarditis and its resulting embolic pneumonia that it also occurs sometimes in the opposite condi- are well recognised, while the arteritis was probably tion, and that various factors affecting the thickness localised at this spot by the existing contraction of the and density of the overlying tissues may influence its vessel. production.22 In short, that there is great difficulty The Physics of the Circulation.?The effect of gravity in explaining its production in any given case. on the circulation if all the vessels were re- Ewart23 argues that the pulmonary second sound is laxed, would, of course, render the brain blood- singularly limited in its area of conduction, while a less in the upright position. Hence an exact co- sound from the aorta is heard far and wide over the ordination must be maintained between the con- cardiac area and beyond it, as shown by the anatomical tractile forces of all the vessels and the pressure due to configuration of the parts. The rare pulsus bisferiens gravity. In a paper before the Royal Society Leonard (as well as the anacrotic one) has been usually regarded Hill showed that this constant compensation is effected as produced by aortic stenosis. It is defined as follows : by the splanchnic vaso-motor mechanism.30 When this ''Both percussion and tidal waves are well repre- is damaged by shock, asphyxia, or chloroform the sented, but the latter, instead of being rounded and cerebral circulation ceases. Chloroform paralyses sustained, forms a sharp angle, Moreover, the second this compensatory mechanism more rapidly than ether, wave begins low, and the two waves reach the same hence the danger of elevating the head in chloroform level or nearly so. The dicrotic wave follows, and its narcosis. Probably, too, emotional syncope is due less degree of development varies." Now G. Steell has to heart failure than to paralysis of the splanchnic given reason to think that this pulse may occur nerves. In short, when this protective agency ceases without aortic stenosis, but rather in regurgita- to act, the blood at once accumulates in the veins and tion. J. Mitchell Clarke describes an undoubted the lowest part of the body. case where imcompetence but no stenosis was Brunton, in the Harveian oration, carefully discussed present on post-mortem examination. He also re- the mechanics of the muscular circulation.31 The blood the ports*4 two other cases in which the pulse occurred supply may be principally sent to either the skin, without any evidence of stenosis though uncon- intestinal tract, or through the muscles, by vaso-motor 10 THE HOSPITAL. April 6, 1895. regulation. Muscular contraction, while it compresses is a morbid susceptibility to cold, which pro- the vessels of that muscle, leads to dilatation of those duces paroxysmal closure of the arteries; gangrene vessels by stimulation of the vaso-dilator nerves. Thus may occur in the paroxysms. (2) Symmetrical gan- gentle exercise may lead to general dilatation of the grene of the extremities, acro-sphacelus, with nothing vessels and lowering of blood pressure, since the vessels paroxysmal about it, and complete recovery of the of the muscles can easily contain all the blood of the circulation after a single attack. (3) Cases in which body, while violent exercise by compressing the vessels the skin passes into a condition of diffuse scleroderma. may raise pressure. Again, in the latter case the Here again is a tendency to paroxysms and gangrene, stimulation of the nerves from the muscles to the but these are merely complications of the scleroderma. heart vastly increases its rate, thus again raising the In true Raynaud's disease there is no such change in pressure. Hence the pain produced by sudden exertion the skin. The best remedy for the pure disease is the habitual use of small doses of in a weak heart, whereas continued and especially very opium. Another is described Levi35 as It can gentle exercise by dilating the vessels of the muscles type by purely hysterical. be ameliorated by but tends to recur. renders circulation more The of this hypnotism, easy. bearing There is often a of rheumatic exercises in previous history fever; physiology on massage and graduated the onset is sudden, and often accompanied by heart disease is obvioua. urinary disturbances, such as polyuria. It is one of the vaso-motor of and Raynaud's Disease-*-M-orton discusses3^ three cases, phenomena hysteria, gangrene sometimes takes Some cases of ainhum are the etiology of each of them being different from the place. described by H. De Brun. A toe is gradually detached others. In one the terminal would at first phalanges without pain, haemorrhage, or sore, by a constriction at turn white, while the re3t of the hand was livid. the digito-plantar fold. The fifth toe generally Eventually this became permanent, and gangrene of is the first to go, and others follow, there is a phalanx followed. This, he thinks, was pure vaso- diminished temperature in the limb, some swelling and some disturbances and loss of knee motor spasm. In the second there had long been in- lividity, sensory and the character found in terstitial Acute in the occurred, jerk, paroxysmal nephritis. pain fingers Raynaud's disease. It nearly always occurs in the with and The arterial lividity, finally gangrene. coloured races. Angiopathic gangrenes must, accord- fibrosis was probably the agent here. The third ing to Lancereaux, be carefully distinguished from patient had syphilis some years previously, the angio-neuroiic.37 The former are marked by severe nerve after which fingers were white and the hands livid, while the nails pains for years beforehand, morti- fied or occur, which never termi- were more or less degenerated.
Load more

Recommended publications
  • 1. Intermittent Chest Pain: Angina: • Stable: (Caused By
    CVS: 1. Intermittent chest pain: Angina: • Stable: (caused by chronic narrowing in one or more coronary arteries), episodes of pain are precipitated by exertion and may occur more readily when walking in cold or windy weather, after a large meal or while carrying a heavy load; the pain is promptly relieved by rest and/or sublingual glyceryl nitrate (GTN) spray, and typically lasts for less than 10 minutes. • unstable angina (caused by a sudden severe narrowing in a coronary artery), there is usually an abrupt onset or worsening of chest pain episodes that may occur on minimal exertion or at rest. • Retrosternal/ Progressive onset/ increase in intensity over 1–2 minutes/ Constricting, heavy/ Sometimes arm(s), neck, epigastrium/ Associated with breathlessness/ Intermittent, with episodes lasting 2–10 minutes/ Triggered by emotion, exertion, especially if cold, windy/ Relieved by rest, nitrates Mild to moderate. • Aggravated by thyroxine or drug-induced anemia, e.g. aspirin or NSAIDs Esophageal: • Retrosternal or epigastric/ Over 1–2 minutes; can be sudden (spasm)/ C: Gripping, tight or burning/ R: Often to back, sometimes to arms/ A: Heartburn, acid reflux/ T: Intermittent, often at night-time; variable duration/ Lying flat/some foods may trigger/ Not relieved by rest; nitrates sometimes relieve/ Usually mild but esophageal spasm can mimic myocardial infarction. 2. Acute chest pain: MI: • SOCRATES: Retrosternal/ Rapid over a few minutes/ Constricting, heavy/ Often to arm(s), neck, jaw, sometimes epigastrium/ Sweating, nausea, vomiting, breathlessness, feeling of impending death (angor animi)/ Acute presentation; prolonged duration/ ’Stress’ and exercise rare triggers, usually spontaneous/ Not relieved by rest or nitrates/ Usually severe.
    [Show full text]
  • CARDIOLOGY Section Editors: Dr
    2 CARDIOLOGY Section Editors: Dr. Mustafa Toma and Dr. Jason Andrade Aortic Dissection DIFFERENTIAL DIAGNOSIS PATHOPHYSIOLOGY (CONT’D) CARDIAC DEBAKEY—I ¼ ascending and at least aortic arch, MYOCARDIAL—myocardial infarction, angina II ¼ ascending only, III ¼ originates in descending VALVULAR—aortic stenosis, aortic regurgitation and extends proximally or distally PERICARDIAL—pericarditis RISK FACTORS VASCULAR—aortic dissection COMMON—hypertension, age, male RESPIRATORY VASCULITIS—Takayasu arteritis, giant cell arteritis, PARENCHYMAL—pneumonia, cancer rheumatoid arthritis, syphilitic aortitis PLEURAL—pneumothorax, pneumomediasti- COLLAGEN DISORDERS—Marfan syndrome, Ehlers– num, pleural effusion, pleuritis Danlos syndrome, cystic medial necrosis VASCULAR—pulmonary embolism, pulmonary VALVULAR—bicuspid aortic valve, aortic coarcta- hypertension tion, Turner syndrome, aortic valve replacement GI—esophagitis, esophageal cancer, GERD, peptic OTHERS—cocaine, trauma ulcer disease, Boerhaave’s, cholecystitis, pancreatitis CLINICAL FEATURES OTHERS—musculoskeletal, shingles, anxiety RATIONAL CLINICAL EXAMINATION SERIES: DOES THIS PATIENT HAVE AN ACUTE THORACIC PATHOPHYSIOLOGY AORTIC DISSECTION? ANATOMY—layers of aorta include intima, media, LR+ LRÀ and adventitia. Majority of tears found in ascending History aorta right lateral wall where the greatest shear force Hypertension 1.6 0.5 upon the artery wall is produced Sudden chest pain 1.6 0.3 AORTIC TEAR AND EXTENSION—aortic tear may Tearing or ripping pain 1.2–10.8 0.4–0.99 produce
    [Show full text]
  • A Case of Dyspnoea and Visible Neck Pulsations
    Online image challenge A case of dyspnoea and visible orthopnoea and palpitations. The symptom aggravation was Heart: first published as 10.1136/heartjnl-2015-308831 on 13 January 2016. Downloaded from abrupt with simultaneous occurrence of both dyspnoea and neck pulsations palpitations. After medical stabilisation, the neck pulsations were as shown in online supplementary video 1. QUESTION What is the most likely cardiac condition? CLINICAL INTRODUCTION A. Aortic regurgitation A 48-year-old male patient with a history of New York Heart B. Congestive cardiac failure Association (NYHA) Class II dyspnoea for the last 2 years C. Tricuspid regurgitation presented with acute onset breathlessness associated with D. Ventricular tachycardia http://heart.bmj.com/ on September 30, 2021 by guest. Protected copyright. Benny PJ, et al. Heart March 2016 Vol 102 No 6 e1 Online image challenge ANSWER: A visible at the root of the neck and no periodicity of pairs as Heart: first published as 10.1136/heartjnl-2015-308831 on 13 January 2016. Downloaded from The major clue here is to find out whether it is an arterial noted in this video. pulsation or a venous pulsation. Typically, an elevated jugular venous pulse ( JVP) will be equally or more prominent at the Panakkal Jose Benny, Gopalan Nair Rajesh, Chakkanalil Govindan Sajeev root of the neck and will show an upper level. The descents Department of Cardiology, Government Medical College, Kozhikode, Kerala, India will be more prominent than the outward pulsations.1 On Correspondence to Dr Panakkal Jose Benny, Senior Resident, Department of the contrary, arterial neck pulsations will be most prominent Cardiology, Government Medical College, Kozhikode 673008, Kerala, India; at the mid-neck level with little or no appreciable pulsation [email protected] at the root of the neck.
    [Show full text]
  • Quick Guide to Cardiopulmonary Care
    Edwards Clinical Education Quick Guide to Cardiopulmonary Care 4th Edition This reference guide is presented as an aide to guide medical personnel by Edwards Lifesciences. The information in this reference guide has been compiled from available literature. Although every effort has been made to report faithfully the information, the editors and publisher cannot be held responsible for the correctness. This guide is not intended to be, and should not be construed as, medical advice. For any use, the product information guides, inserts and operation manuals of the various drugs and devices should be consulted. Edwards Lifesciences and the editors disclaim any liability arising directly or indirectly from the use of drugs, devices, techniques or procedures described in this reference guide. Note: Algorithms and protocols included in this book are for educational reference only. Edwards does not endorse or support any one specific algorithm or protocol. It is up to each individual clinician and institution to select the treatment that is most appropriate. ISBN 978-0-615-96605-2 Quick Guide to Cardiopulmonary Care 4th Edition Editors William T. McGee, MD, MHA, FCCP, FCCM Critical Care Medicine Associate Professor of Medicine and Surgery University of Massachusetts Medical School Caulette Young, BSN, RN, CCRN, CHSE Clinical Nurse Consultant John A. Frazier, BS, RN, RRT Sr. Manager Edwards Lifesciences Previous edition editor Peter R. Lichtenthal, M.D. Previous editions contributors and reviewers Diane K. Brown, RN, MSN, CCRN Barbara “Bobbi” Leeper, MN, RN, CCRN Quick Guide to Cardiopulmonary Care Pertinent clinical information dedicated to the critical care clinician The intent of the Quick Guide is to provide a ready reference for hemodynamic monitoring and oxygenation assessment of the critically ill.
    [Show full text]
  • Pulse 1 Pulse
    Pulse 1 Pulse In medicine, a person's pulse is the arterial palpation of a heartbeat.[1] It can be felt in any place that allows for an artery to be compressed against a bone, such as at the neck (carotid artery), at the wrist (radial artery), behind the knee (popliteal artery), on the inside of the elbow (brachial artery), and near the ankle joint (posterior tibial artery). The pulse rate can also be measured by measuring the heart beat directly (auscultation), usually using a stethoscope. Physiology The pulse is a decidedly low tech/high yield and antiquated term still useful at the bedside in an age of computational analysis of cardiac performance. Claudius Galen (129AD?) was perhaps the first physiologist to describe the pulse. The pulse is an expedient tactile method of determination of systolic blood pressure to a trained observer. Diastolic blood pressure is non-palpable and unobservable, occurring between heartbeats. Pressure waves generated by cardiac systole move the artery walls, which are pliable and compliant. These properties form enough to create a palpable pressure wave. The heart rate can be (much) higher than the pulse rate depending upon the cause or etiology. In this case, the heart rate is determined by auscultation of the heart apex, in which case it is not the pulse. The pulse deficit (difference between heart beats and pulsations at the periphery) is determined by simultaneous palpation at the radial artery and auscultation at the heart apex. Pulse velocity, pulse deficits and much more physiologic data is readily and simplistically visualized by the use of one or more arterial catheters connected to a transducer and oscilloscope.
    [Show full text]
  • Represented, but the Latter, Instead Or Being Rounded Muscles ; Both Rise and Fall Are Rapid and the Line of the and Sustained, Forms a Sharp Angle
    1529 begun aouve at the tlllH1 1-10, and transvetsely Excended from ON THE PULSUS BISFERIENS OF AORTIC the right border of the sternum to a point nearly one inch to REGURGITATION.1 the left beyond the posirjon of the maximum Impulse. A long, soft diastolic murmur in the aortic area entirely replaced the MICHELL M.D. BY J. CLARKE, M A, CAMB., aortic second sound, aLd was conducted upwards but more M.R.C.P. LOND., distinctly downwards along the left border of the sternum, PHYSICIAN TO THE GENERAL HOSPITAL, AND LECTURER ON PRACTICAL and was audible at the apex. the first sound at the PHYSIOLOGY, UNIVERSITY BRISTOL. COLLEGE, apex was indistinct, and sometimes during his stay in hospital a systol’c murmur appealed there. No systolic SHORTLY after reading the very instructive and interest- murmur was heard at the base. The pulmonary second ing papers of Dr. Graham Steell on this subject,2 and sound was feeble. There was a little dulness at the base of the left and the liver and were both to which I here express my indebtedness, a well-marked lung, fpleen There was no and the urine did not contain of the somewhat rare of this described enlarged. dropsy .example type pulse albumen. A cardiographic tracing at this time, taken him came under own observation. This of by my variety over the seat of the maximum ventricular impulse, showed pulse is generally described as a form produced by aortic delay in the pulse wave (only an indication and not a good stenosis, but occurring much more rarely than the more tracing of the brachial pulse was obtained) ; in the ventri- cisual modification of the pulse found in this lesion-namely, cular curve the rise due to the auricle was well marked, and a the anacrotic pulse.
    [Show full text]
  • Hysteresis Compensation in a Tactile Device for Arterial Pulse Reproduction
    sensors Article Hysteresis Compensation in a Tactile Device for Arterial Pulse Reproduction Fernando Carneiro *,†, Paulo Abreu ID and Maria Teresa Restivo ID LAETA—INEGI, Associated Laboratory for Energy, Transports and Aeronautics—Institute of Science and Innovation in Mechanical and Industrial Engineering, University of Porto, 4200-465 Porto, Portugal; [email protected] (P.A.); [email protected] (M.T.R.) * Correspondence: [email protected] † Current Address: Rua Dr. Roberto Frias, 400 Porto, Portugal. Received: 6 April 2018; Accepted: 15 May 2018; Published: 19 May 2018 Abstract: This paper describes a system for training healthcare practitioners in the identification of different arterial pulses. The driving system uses a linear solenoid in an open loop force control. Due to the large hysteresis it exhibited, a form of compensation was implemented, based on the classic Preisach model of hysteresis. Implementation of said model resulted in a significant reduction of force tracking error, demonstrating the feasibility of the chosen approach for the intended application. Keywords: hysteresis compensation; preisach model; feedforward controller; palpation simulation; tactile interface 1. Introduction Palpation of the pulse is a medical technique that allows a physician to rapidly assess the status of a given person’s cardiovascular system. It can be a good source of information, as it enables the physician to perform a rough measurement of heart rate, rhythm, strength of contraction and artery elasticity [1]. This allows estimation of the pulse waveform, which can be an indicator of the development of different cardiovascular diseases [2–5]. Examples include the pulsus bisferiens, pulsus paradoxus and pulsus alternans, that are associated with conditions such as aortic stenosis and regurgitation, hypertrophic cardiomyopathy, pericardial tamponade, restrictive pericardis and dilated cardiomyopathy [3].
    [Show full text]
  • Paper 1 Questions
    CUM1 2/15/05 4:33 PM Page 3 QUESTIONS 1 Paper 1 Questions MCQs [1] Concerning cardiac failure . (c) Dressler’s syndrome (a) valvular disease is the most common cause in the UK (d) electromechanical disociation (b) raised levels of atrial natriuretic peptide (ANP) are (e) left ventricular aneurysm thought to be beneficial in heart failure (c) a third heart sound is a common finding on [5] The following cardiac events are matched correctly ausculation to the corresponding ECG changes . .. (d) the heart looks small on plain postero-anterior (a) inferior infarct Æ ST-segment depression in leads chest radiograph II,III and aVF (e) all diuretics used in treatment of cardiac failure (b) pericarditis Æ downward-sloping ST-segment potentially cause hypokalaemia depression in all anterior chest leads (c) atrial fibrillation Æ irregularly irregular P-waves [2] Concerning hypertension . (d) first degree heart block Æ broad QRS complexes (a) approximately 50% of all cases of hypertension are (e) ventricular aneurysm Æ persistent ST-segment caused by renal dysfunction elevation in chest leads (b) patients with Conn’s syndrome usually have a raised [6] In peripheral arterial occlusive disease... serum potassium level (a) the relationship between radius of artery and flow (c) hypothyroidism does not cause hypertension within it is described by the Fick principle (d) the ‘Cushing reflex’is an increase in systolic blood (b) claudication means ‘cramping’in Latin pressure that occurs secondary to Cushing’s (c) Leriche syndrome is arterial occlusive disease below syndrome the popliteal trifurcation (e) malignant hypertension can be diagnosed on (d) ‘rest pain’commonly occurs in the feet and fundoscopy alone metatarsal heads (e) arterial ulcers are usually painless [3] Acute myocardial infarction .
    [Show full text]
  • Cardiovascular Examination
    Muhammed Akunjee and Nazmul Akunjee GP Principals, London, UK Zeshaan Maan, Surgical Trainee, London, UK and Mina Ally Foundation Doctor, Dartford, UK © Scion Publishing Ltd, 2012 ISBN 978 1 904842 78 1 First published in 2012 All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission. A CIP catalogue record for this book is available from the British Library. Scion Publishing Limited The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury, Oxfordshire OX16 9UX www.scionpublishing.com Important Note from the Publisher The information contained within this book was obtained by Scion Publishing Limited from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention. Readers should remember that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of
    [Show full text]
  • Download Demo
    ExamsBoost Boost up Your Certification Score AACN CMC Cardiac Medicine Certification For More Information – Visit link below: https://www.examsboost.com/ Product Version Up to Date products, reliable and verified. Questions and Answers in PDF Format. Visit us athttps://www.examsboost.com/test/cmc/ Question: 1 Which of the following findings is suggestive of pulsus paradoxus? A. Inspiratory drop in SBP > 10 mmHg B. Expiratory drop in SBP > 10 mmHg C. Inspiratory rise in SBP > 10 mmHg D. Expiratory drop in SBP > 10 mmHg Answer: A Explanation: The finding suggestive of pulsus paradoxus is inspiratory drop in SBP > 10 mmHg. Pulsus paradoxus can be found in cardiac tamponade, constrictive pericarditis, airway obstruction, superior vena cava (SVC) obstruction, COPD, and asthma. Question: 2 The nurse is preparing to record the blood pressure of a patient. What should be the correct position of the patient and arm? A. Patient sitting on chair taken in left arm B. Patient supine and upright taken in both arms C. Patient in any position taken in any of the arms D. Patient lying down on bed taken in right arm Answer: B Explanation: The correct position of the patient and arm is that blood pressure should be taken in both arms with the patient supine and upright with the arm at the level of heart. Dependency of the arm below heart level leads to an overestimation of systolic and diastolic pressures of about 10 mm Hg and raising the arm above heart level leads to underestimation of blood pressures. Question: 3 Which of the following correctly defines pulse pressure? A.
    [Show full text]
  • Systolic Ejection Murmur Presenting with Dyspnea on Exertion
    CARDIOVASCULAR BOARD REVIEW C. RIMMERMAN, B.P. GRIFFIN, EDITORS A SELF-TEST ON A TOBIAS PEIKERT, MD CRAIG R. ASHER, MD BRIAN P. GRIFFIN CLINICAL Department of Internal Medicine, Department of Cardiovascular Department of Cardiovascular Cleveland Clinic Medicine, Cleveland Clinic Medicine, Cleveland Clinic CASE Systolic ejection murmur presenting with dyspnea on exertion 43-YEAR-OLD WOMAN was referred to ■ DIFFERENTIAL DIAGNOSIS A the cardiology outpatient clinic for OF SYSTOLIC EJECTION MURMUR evaluation of a systolic ejection murmur. Her symptoms at presentation consisted of dysp- Which of the following conditions should nea on exertion, decreased exercise tolerance, 1 not be included in the differential diagno- generalized fatigue, and intermittent palpita- sis of a systolic ejection murmur? tions. Her functional impairment was consis- tent with New York Heart Association ❑ Aortic valve stenosis (NYHA) class 2 to class 3. She had a known ❑ Mitral valve regurgitation cardiac murmur since childhood. In the past ❑ Aortic valve sclerosis she experienced presyncopal episodes and, on ❑ Hypertrophic cardiomyopathy one occasion, syncope. ❑ Subaortic membrane She admits to the social use of cigarettes and alcohol. Her father had coronary artery Mitral valve regurgitation is the only one of disease and diabetes mellitus, and an uncle the above conditions that does not present had died suddenly of an unknown cause. with a systolic ejection murmur. Keep an open Systolic murmurs are characterized as mind when Physical examination “ejection” (TABLE 1) or “regurgitant”. Systolic Her vital signs were within normal limits. She ejection murmurs are audible only during part evaluating had no carotid bruits or jugular venous disten- of systole, that is, they begin after S1 and end patients with tion.
    [Show full text]
  • General Examination and the Pulse
    22 . SYSTEMS - CARDIOVASCULAR GENERAL EXAMINATION AND THE PULSE Carotid GENERAL EXAMINATION ../ !1J;.'. ---..d ". n­ A general assessment of the cardio­ :'I_I " .:2J vascular system (Table 1) should take ~;~ ~ -I( into account the patient's age and sex. It is also essential to determine if the patient: • is in pain • is experiencing shortness of breath • has a cough • is pale or cyanosed • has evidence of fluid retention • has the 'mitral' facial appearance (dilated cyanotic vessels over the cheek bones) • has chest operation scars • has tar-stained fingers Vein • has signs of hyperlipidaemia t ... Pubic tubercle (including fat deposits in the skin). Fig. 1 The routinely palpated pulses. The first part of the patient that a doctor usually comes into contact with much more information about the pulse produce a detectable peripheral impulse. is the hands, and their temperature and character. It is important to detect a pulse deficit as colour should be noted. Peripheral cyanosis When palpating the pulse, pay particular a normal peripheral pulse rate may con­ in the absence of central cyanosis might attention to five major characteristics: ceal an inefficient fast heart rate. A pulse suggest inadequacy of peripheral circula­ rate, rhythm, volume, cbaracter and state deficit may be found in atrial fibrillation, tion, as would coldness of the peripheries. of the vessel wall. 'extra' beart beats (extrasystoles) and in Clubbing, in the presence of heart dis­ At some stage of the examination, the heart block. In atlial fibrillation the pulse ease, suggests either cyanotic congenital rest of the peripheral pulses (Fig. I) rate is irregular and, unlike the pulse healt disease or infective endocarditis.
    [Show full text]