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Cardiology to Impress 6

Cardiology to Impress 6

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Published by Thirugnana Thiru

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Published by: Thirugnana Thiru on Oct 15, 2011
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05/18/2012

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Look out for the following signs:

•Pulse — tachycardia or pulsus alternans — (alternating weak and
strong pulse — commonly quoted in books but is uncommon in
practice).
•Neck — raised JVP (see Chapter 2 —Bedside teachingfor full details).

Commonly Encountered Conditions

151

b865_Chapter-04.qxd 3/16/2010 4:47 PM Page 151

CARDIOLOGY TO IMPRESS - The Ultimate Guide for Students and Junior Doctors
© Imperial College Press
http://www.worldscibooks.com/medsci/p704.html

•Chest (anteriorly) — laterally displaced apex beat secondary to
cardiomegaly, right ventricular heave, gallop rhythm secondary to
summation of heart sounds 3 (S3) +4 (S4).
•Chest (posteriorly) — bibasal crackles suggest ‘acute pulmonary
oedema’, stony dull percussion notes (heard in pleural effusion,
also associated with reduced air entry).
•Abdomen — ascites (demonstrate shifting dullness/fluid thrill —
see Appendix), hepatomegaly, pulsatile liver (seen in tricuspid
regurgitation).
•Sacrum/legs — demonstrate ‘pitting oedema’ as previously
described.

152

Chapter 4

Figure 4.8Radiological features of acute pulmonary oedema

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