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Paediatric

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CVS

Question
44 out of 63
 

Not true about impending Eisenmenger? (AIIMS May 2010)



A Increasing intensity of tricuspid & pulmonary murmur

B Increased intensity P2

C Appearance of graham steel murmur

D Normalization of size of left ventricle and right ventricle

Ans. D

Normalisation of size of left ventricle and right ventricle Ref: Nelson textbook of Pediatrics 17th Page, 1936

Eisenmenger's syndrome:

1. Symptoms do not usually develop until the 2nd or 3rd decade of life, although a more fulminant course may occur.

2. Many patients survive for decades with minimal symptoms. Intracardiac or extracardiac communications that would normally shunt from left to right are converted to right-to-left shunting as pulmonary vascular resistance exceeds systemic vascular resistance.

3. Cyanosis becomes apparent, and dyspnea, fatigue, and a tendency toward dysrhythmias begin to occur. In the late stages of the disease, heart failure, chest pain, headaches, syncope, and hemoptysis may be seen.

4. Physical examination reveals a right ventricular heave and a narrowly split 2nd heart sound with a loud pulmonic component.

5. Palpable pulmonary artery pulsation may be present at the left upper sternal border.

6. A holosystolic murmur of tricuspid regurgitation may be audible along the left sternal border.

7. An early decrescendo diastolic murmur of pulmonary insufficiency (graham steel murmur) may also be heard along the left sternal border. The degree of cyanosis depends on the stage of the disease.

Diagnosis:

1. Cyanotic patients have various degrees of polycythemia that depend on the severity and duration of hypoxia.

2. Roentgenographically, the heart varies in size from normal to greatly enlarged; the latter usually occurs late in the course of the disease.

3. The main pulmonary artery is generally prominent, similar to primary pulmonary hypertension.

4. The pulmonary vessels are enlarged in the hilar areas and taper rapidly in caliber in the peripheral branches. The right ventricle and atrium are prominent.

5. The electrocardiogram shows marked right ventricular hypertrophy. The P wave may be tall and spiked.

6. The echocardiogram shows a thick-walled right ventricle and demonstrates the underlying congenital heart lesion.

7. Two-dimensional echocardiography assists in eliminating from consideration lesions such as obstructed pulmonary veins, a supramitral membrane, and mitral stenosis.

8. The pulmonary valve echocardiogram shows a characteristic early midsystolic closure, the “W sign.”

9. Doppler studies demonstrate the direction of the shunt and the presence of a typical hypertension waveform in the main pulmonary artery.

Tricuspid and pulmonary regurgitation can be used in the Doppler examination to estimate pulmonary arterial pressure.

CVS Flashcard List

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