Ebook Cardiology clinical questions: Part 2
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Ebook Cardiology clinical questions: Part 2
SECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2nt information about the patient cardiac status is obtained by physical examination of arterial pulses. A differential diagnosis can be made by inspecting the arterial blood pressure and central/ peripheral pulses.Patient being evaluated presents with abnormal pulses on physical exam.HISTORYPHYSICAL Ebook Cardiology clinical questions: Part 2 EXAMListen for murmurs, rubs, gallops, location of cardiac impulse, parasternal lifts.s SYNTHESISSWP = Small Weak Pulse. HKP = HypoKinetic Pulse. DPEbook Cardiology clinical questions: Part 2
= Delayed Pulse. LBP = Large Bounding Pulse. DPP = Double Peak Pulse PWSD = Palpable Waves: 1 in Systole, 1 in Diastole. AAP = Alteration of AmplitudeSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2amplitude. pp = Pulsus Parvus (dimished left ventricular stroke volume, narrow pulse pressure, increased peripheral vascular resistance) HV = HyopVolemia LVF = Left Ventricular Failure RC = Restrictive Cardiomyopathy MS = Mitral Stenosis PT = Pulses Tardus: aortic stenosis with delayed systolic peak Ebook Cardiology clinical questions: Part 2, left ventricular obstruction. KERKP = HypERKinetic Pulse-increased LV stroke volume, wide pulse pressure, decreased peripheral vascular resistance:Ebook Cardiology clinical questions: Part 2
AV fi stulas, mitral regurgitation, ventricular septal defect. BWC = Bisferiens/Water hammer/Corrigan: aortic regurgitation, hypertrophic cardiomyopatSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2tamponade, airway obstruction, superior vena cava obstruction. RFD = RadioFemoral Delay: coarcation of aorta.EXAMINATION 109EPIPHANYSWP = pp HKP = HV or LVF or RC or MS DP = PT LBP = HERKP DPP = BWC PWSD = DICR AAP = PALT DPDI = PPAR SOLE = RFDDISCUSSIONThe arterial pulse begins when the aortic valv Ebook Cardiology clinical questions: Part 2e opens and left ventricle contracts. There is a rapid rise called the anacrotic notch: then during isovolumic relaxation, there is a reversal of flowEbook Cardiology clinical questions: Part 2
prior to aortic valve closure which is called the incisura.PEARLSPalpate all pulses and note for any differences between them, as well as do simultanSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2egular pulses are seen in PAC/PVC, irregular irregular pulses seen in atrial fibrillation./■ REFERENCE1)Chizner M, ed. Classic Teachings in Clinical Cardiology: A Tribute to w. Proctor Harvey. Cedar Grove, NY: Laennec: 1996. 2)Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrisons Principles Ebook Cardiology clinical questions: Part 2of Internal Medicine. 15th ed. New York, NY: McGraw-Hill: 2007.110 EXAMINATIONWhat is the likely heart murmur I hear?KEY CONCEPTAuscultation 0Í murmurEbook Cardiology clinical questions: Part 2
s is reliable and cost effective to make diagnosis of various heart conditions.□ HISTORYAsymptomatic/symptomatic patient with murmur presenting with oSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2eard without stethoscope without contact to chest). Note the configuration (crescendo, decrescendo, diamond shaped, plateau), onset and cessation, location, radiation, time during cardiac cycle, and response to maneuvering.IMAGINGTwo-dimensional Echo and color Doppler flow.X g SYNTHESIS (cont. on ne Ebook Cardiology clinical questions: Part 2xt page)Systolic Murmurs: MR = Mitral Regurgitation. TR = Tricuspid Regurgitation. VSD = Ventricular Septal Defect. IM = Innocent Murmur. AS = AorticEbook Cardiology clinical questions: Part 2
Stenosis. PS = Pulmonic Stenosis. HOCM - Hyertrophic Obstructive CardioMyopathy. MVP = Mitral Valve Prolapse. ASD = Atrial Septal Defect. CAV = CalcifSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2olic Murmurs: AR = Aortic Regurgitation. PR = Pulmonic Regurgitation. MS = Mitral Stenosis. TS - Tricuspid Stenosis. ED = Early Diastolic. MRD = Mid-Rumbling Diastolic.EXAMINATION 111X X SYNTHESIS (cont. from previous page)Continuous Murmurs: PDA = Patent Ductus Arteriosus. CONT = CONTinuous venous Ebook Cardiology clinical questions: Part 2hum.E EPIPHANYMR/TR/VSD = HS IM = MDE AS/PS/HOCM/ASD = MSM MVP = MSC CAV = IA AR/PR = ED MS/TS = MRD PDA = CONTDISCUSSIONThe presence of murmurs shoulEbook Cardiology clinical questions: Part 2
d be taken into the context of the patient with importance of noting presence of known cardiac and symptoms. The approach to the patient should first SECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2propriate. Systolic murmurs grade 1-2 without symptoms, or other findings do not require further workup. Systolic murmurs 1-2 with symptoms or cardiac findings or grade 3 or higher holosystolic or late should be evaluated with echocardiography.PEARLSAll diastolic/holosystolic/late systolic murmurs a Ebook Cardiology clinical questions: Part 2re pathologic. Early and midsystolic murmurs may be functional. Accentuation during inspiration implies origination on the right side and during expirEbook Cardiology clinical questions: Part 2
ation implies origination on the left side. Valsalva reduces intensity of most by reducing ventricular filling except MVP and HOCM (which are louder uSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2The Heart. 12th ed. New York, NY: McGraw-Hill; 2008. 2)Fauci AS, Braundwald E, Isselbacher KJ, et al., eds. Harrison’s Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2007.112 EXAMINATIONDoes my patient need preoperative cardiac testing for noncardiac surgery?KEY CONCEPTThe deci Ebook Cardiology clinical questions: Part 2sion to perform preoperative cardiac testing for noncardiac surgery is best on underlying cardiac conditions, risk factors, type or procedure, and theEbook Cardiology clinical questions: Part 2
patient’s functional capacity.HISTORYHPI: Patient with underlying cardiac condition undergoing noncardiac surgery. PMH: Coronary artery disease, congSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportan Ebook Cardiology clinical questions: Part 2n, ST-segment depression, deep Q waves (>1 mm), PR interval irregularly variable, narrow QRS complex.1 IMAGINGX-ray: Cardiomegaly, cephalization of pulmonary vessels (increased distribution of flow to apices), pleural effusion. ECHO: Left ventricular ejection fraction <40%, left atrial and left vent Ebook Cardiology clinical questions: Part 2ricular enlargement; mitral valve annular calcification, thickened/calcific aortic valve, bicuspid aortic valve.SECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportanSECTION VEXAMINATION108 EXAMINATIONWhat are the abnormal pulses in my patient and what cardiac conditions are they associated with?KEY CONCEPTImportanGọi ngay
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