harrison's internal medicine
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- Treatment for obstructive sleep apnea?
- Continuous positive airway pressure (CPAP) Pulmo vol 2 page 1667
- Causes of pulsus purvus ( weak pulse) ?
- Decrease LV stroke volume A narrow pulse pressure Inc peripheral vascular resistance
- Causes of hypokinetic pulse?
- Hypovolemia LV failure Restrictive pericardial disease MV stenosis
- Cause of pulsus tardus?
- AV stenosis
- Causes of hyperkinetic pulse?
- Increase LV stroke volume Decrease in peripheral vascular resistance Complete heart block Anemia Exercise Fever PDA Peripheral AV fistula MR, VSD, AR
- Causes of dicrotic pulse?
- Very low stroke volume e.g. dilated cardiomyopathy
- Causes of pulsus alterans?
- Paroxysmal tachycardia Severe LV dysfunction
- Cause of pulsus bigeminus?
- PVCs
- Causes of pulsus paradoxus ( > 10 mmHg dec in SBP with inspiration)?
- Pericardial tamponade Airway obstruction SVC obstruction
- Component of a JVP wave forms?
- Wave forms A wave – venous distention due to right atrial contraction C wave – inc venous pressure due to bulging tricuspid valve ( during IVCD) + impact of the carotid artery to the internal jug vein X descent – atrial relaxation V wave – increasing blood volume in the right atrium Y wave – when tricuspid opens up
- Causes of large a waves (cannon A waves)?
- Tricuspid stenosis Pulmonary hypertension Pulmonic stenosis Junctional rhythm AV dissociation
- Cause of an absent a wave?
- Atrial fibrillation
- Cause of an increase in delay between the a wave and carotid pulse?
- First degree AV block
- Whats the normal JVP?
- 8 cm blood ( from the sternal angle)
- Whats a positive abdominojugular reflux?
- Increase in JVP during a10 sec firm abdominal compression
- Whats a kausmauls sign?
- Increase rather than a decrease in CVP during inspiration A sign of severe right sided failure
- Cause of lateral downward displacement of the apical pulse?
- LVH
- Cause of double systolic apical pulse?
- Hypertrophic cardiomyopathy
- Cause of sustained systolic lift?
- RVH
- Cause of right parasternal lift?
- MR
- Cause of a thrill in the cardiac apex?
- MR
- Thrill from the precordium to the RIGHT side of the neck?
- AS
- Thrill from the precordium to the LEFT side of the neck?
- PS
- Etiology of the heart sounds?
- S1 – closure of the AV valve S2 – closure semilunar valves S3 – rapid filling of the ventricle ( first 2/3 of diastole) S4 – contraction of the atrium against a non compliant ventricle ( last 1/3 of diastole)
- Murmurs which increases during inspiration ( a maneuver which increases systemic venous return)?
- Right sided murmurs TR TS PS PR
- Effect of valsalva maneuver on murmurs ( decrease R and L Vent filling)?
- Decreases all murmurs except for HOCM and MVP
- Effect of standing on murmurs ( decrease L Vent filling)?
- Decreases all murmurs except for HOCM and MVP
- Effect of hand grip exercise in murmurs ( increases systemic arterial pressure and HR)?
- Increases MR VSD AR Decreases MS PS HCOM