STEP2: CARDS: PhysEx Flashcards
(7 cards)
In what conditions might you observe this BP finding?
Constrictive pericarditis
Cardiac tamponade
Severe obstructive airway disease (asthma, COPD)
Obstructive sleep apnea
Croup
Tension pneumothorax
Superior vena cava syndrome
What is this finding:
Pulsus paradoxus: pathological decrease in the pulse wave amplitude and systolic blood pressure > 10 mm Hg during inspiration
Decrease of intrathoracic pressure during inspiration → expansion of vena cava and right atrium → ↑ venous return → ↑ RV filling
↓ Pericardial compliance (e.g., due pericardial rigidity in constrictive pericarditis) → ↑ bowing of the ventricular septum into the left ventricle → ↓ LV ejection volume → ↓ systolic blood pressure
right parasternal heave
A right parasternal heave is a visible and palpable lift of the sternum, indicating increased workload and enlargement of the right ventricle. It’s most commonly seen in conditions like pulmonary hypertension, where the right ventricle struggles to pump blood into the lungs.
Kussmal Sign
A sign characterized by distention of the jugular veins during inspiration (due to elevation of jugular venous pressure). Can be seen in patients with constrictive pericarditis, restrictive cardiomyopathy, right ventricular infarction, and tricuspid stenosis.
A physical examination finding in which there is an exaggerated decrease (> 10 mm Hg) in systolic blood pressure during inspiration. Classically associated with cardiac tamponade and constrictive pericarditis, but can also be seen in noncardiac conditions (e.g., massive pulmonary embolism, hemorrhagic shock, obstructive sleep apnea, obstructive lung disease).
Pulsus paradoxus
A high-pitched, early-diastolic sound that sounds like a premature S3 and is often present in patients with constrictive pericarditis. Caused by the sudden slowing of blood flowing into the ventricle during diastole because relaxation of the ventricle is impaired by the rigid pericardial sac. The knock is best heard between the apex of the heart and the left sternal border.
Pericardial knock
a common benign finding on auscultation in childhood. The murmur is most likely caused by turbulence in the internal jugular vein (e.g., when blood enters the thoracic inlet).
Venous hum
The murmur disappears or becomes softer on compression of the internal jugular vein, lying in the supine position, or flexion of the head, as seen here. This feature helps differentiate it from the murmur in a patent ductus arteriosus.
The murmur disappears or becomes softer on compression of the internal jugular vein, lying in the supine position, or flexion of the head, as seen here. This feature helps differentiate it from the murmur in a patent ductus arteriosus.
venous hum
