Download Cardiology Secrets 3e PDF Free

Download Cardiology Secrets 3e PDF Free
by Levine (Author)

Editor’s Note to Readers: For an excellent and more detailed discussion of the cardiovascular physical examination, read Physical Diagnosis Secrets, ed 2, by Salvatore Mangione.
1. What is the meaning of a slow rate of rise of the carotid arterial pulse? A carotid arterial pulse that is reduced(parvus)and delayed(tardus)argues foraortic valvular stenosis. Occasionally this also may be accompanied by a palpable thrill. If ventricular function is good, a slower upstroke correlates with a higher transvalvular gradient. In left ventricular failure, however,parvusandtardus may occur even with mild aortic stenosis (AS).
2. What is the significance of a brisk carotid arterial upstroke? It depends on whether it is associated withnormalorwidenedpulse pressure. If associated with normal pulse pressure,a brisk carotid upstroke usually indicates two conditions: &Simultaneous emptying of the left ventricle into a high-pressure bed (the aorta) and a lower pressure bed: The latter can be the right ventricle (in patients with ventricular septal defect [VSD]) or the left atrium (in patients with mitral regurgitation [MR]). Both will allow a rapid left ventricular emptying, which, in turn, generates a brisk arterial upstroke. The pulse pressure, however, remains normal. &Hypertrophic cardiomyopathy (HCM):Despite its association with left ventricular
obstruction, this disease is characterized by a brisk and bifid pulse, due to the hypertrophic
ventricle and its delayed obstruction. If associated withwidenedpulsepressure,a brisk upstroke usually indicates aortic regurgitation (AR). In contrast to MR, VSD, or HCM, the AR pulse has rapid upstrokeandcollapse

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