Loading....
Coupon Accepted Successfully!

Medicine

Open Flashcards

Cardiology

Question
19 out of 19
 

Electric alternans is seen in: (DNB Dec 2012)



A Cardiac tamponade

B Restrictive cardiomyopathy

C Constructive pericarditis

D Right Ventricular MI (RVMI)

Ans. A

Cardiac tamponade

Signs:

1. Increase Pulse rate,

2. Low BP, pulsus paradoxusQ,

3. Raised JVP,

4. Muffled heart sound.

5. Ewart sign is positive Q

6. S3 is absent Q,

7. Y descent is never prominent Q(AIIMS Nov 07)

8. X descent is prominent.

9. Ewart's sign: large effusion compressing left lower lobe. Look for signs of cardiac tamponade.


Diagnosis:

Beck's triad:

1. Falling BP;

2. Rising JVP;

3. Small, quiet heart. (AIIMS May 2011)

Investigation:

1. CXR big globular heart.

2. ECG: low voltageQ, electrical alternans Q.

3. Echo is diagnostic: echo-free zone around the heart

4. Cath: diastolic collapse of right atrium and right ventricle. Q

Extra Edge: Equalization of diastolic pressure occurs in both CP and CT

Management:

1. The pericardial effusion needs urgent drainage.

2. Treat the basic cause.

Table 232-2 Features that Distinguish Cardiac Tamponade from Constrictive Pericarditis and Similar Clinical Disorders (Ref. Hari-18th ed., Pg 1975, Table 239-2)

Characteristic

Tamponade

Constrictive Pericarditis

Restrictive Cardiomyopathy

RVMI

Clinical

Pulsus paradoxus

Common

Usually absent

Rare

Rare

Jugular veins

Prominent y descent

Absent

Usually present

Rare

Rare

Prominent x descent

Present

Usually present

Present

Rare

Kussmaul's sign

Absent

Present

Absent

Present

Third heart sound

Absent

Absent

Rare

May be present

Pericardial knock

Absent

Often present

Absent

Absent

Electrocardiogram

Low ECG voltage

May be present

May be present

May be present

Absent

Electrical alternans

May be present

Absent

Absent

Absent

Echocardiography

Right atrial collapse and RVDC

Present

Absent

Absent

Absent

Increased early filling,

Increased mitral flow velocity

Absent

Present

Present

May be present

Cardiac catheterization

Equalization of diastolic pressures

Usually present

Usually present

Usually absent

Absent or present

Cardiology Flashcard List

19 flashcards
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)