A patient comes in with a pulse of 110, systolic blood pressure around 100 mmHg with distended neck veins. She is standing and leaning over the bed and won't lie down because she feels like she is suffocating when she does. You hear crackles in her lungs and note trace edema in her legs. What is likely to happen to her blood pressure with inspiration? What is the most likely diagnosis?
This patient would mostly likely exhibit pulsus paradoxus (10+ mmHg drop in systolic BP upon inspiration). This is likely cardiac tamponade. Pericardial fluid is putting pressure on the right ventricle, decreasing blood flow to the left ventricle and decreasing systolic blood pressure.
A patient comes to see you for a regular check up. When listening to her heart, you hear persistent splitting of S2. Where is blood flowing in this patient?
Persisten splitting of S2 = atrial septal defect. This happens when there is a hole in the atrial septum and blood flows from the left atria to the right atria. This results in an increase in right atrial pressure which causes the persistent S2 splitting.
A patient comes in with a condition that causes back flow of blood into the left ventricle. When would you hear this heart murmur?
This patient has an aortic regurgitation. The murmur would begin at the very end of systole (after S1) and peter out towards the end of diastole.
A 15 year old girl comes in with a history of tachy palpitations. Her EKG is shown below. How do you expect her EKG to change after she gets her scheduled ablation procedure?
Note the shortened PR interval and slurred upstroke to the QRS (delta wave) that indicate WPW. The PR interval increase will be the most significant observation after ablation.