Wednesday, August 10, 2011
•It is also known as :Stress-induced cardiomyopathy, apical ballooning syndrome, or broken heart syndrome
•Characterize d by transient systolic dysfunction of the apical and/or mid segments of the left ventricle
–mimics myocardial infarction with ST segment changes
–absence of obstructive coronary artery disease
•Typically presets w. RSCP, but occassionaly with new onset dyspnea
–Women >> Men
–Often at time of intense physical or emiotional stress
•Pathogenesis not well understood
–? Catecholamine surge
See a nice brief article in CMAJ here.
Cardiac tamponade is a clinical syndrome with a few defining characteristics:
-hemodynamic instability (hypotension, tachycardia)
-pulsus paradoxus >10 mmHg
-jugular venous distention
- reduced heart sounds
The primary physiologic abnormality is compression of all cardiac chambers as a result of increasing intrapericardial pressure, which is mostly determined by the rapidity of fluid accumulation, rather than the absolute size of an effusion.
The diagnostic modality of choice is doppler echocardiography. In the presence of an effusion, some echocardiographic signs of tamponade:
- Early diastolic collapse of the right ventricle
- Late diastolic collapse of the right atrial free wall
- Less specific than RV collapse unless lasting for >30% of cardiac cycle
-Left atrial collapse
- Only in 25% of cases, but is highly specific
-Accentuated respiratory variation in peak mitral and tricuspid inflow velocities
-Reduction/absence of the normal decrease in inferior vena cava diameter during inspiration
See here for a good NEJM review
See here for the JAMA acticle "Does This Patient With a Pericardial Effusion Have Cardiac Tamponade?"
Tuesday, August 9, 2011
Auricular cartilage calcification and even true ossification of the auricular cartilages have been described in association with:
–mechanical tissue injury
–exposure to cold
–endocrinopathies including adrenal isufficiency
See more from NEJM here.
Monday, August 8, 2011
The classic digitalis effect has 4 typical findings on ECG:
- Virtually any: flattening, inversion, other abnormal waveforms such as peaking of the terminal portion (seen in about 10% of patients)
3.Sagging or “scooped” ST-segment with concomitant ST-segment depression
- More pronounced in leads with tall R waves (e.g. lateral leads)
4.Increase in the U-wave amplitude
It is important to remember that these do not correlate with toxicity as they can be seen at levels well within normal therapeutic range.
For a good review on this and the other important arrythmias assiociated with digoxin toxixicy, see here.
Thursday, August 4, 2011
–Autosomal dominant inheritance
–New mutations primarily in paternal chromosomes
–Complete penetrance but variable expression
•At least 2 of the following features needed to make the diagnosis:
–6 or more café-au-lait macules
–2 or more neurofibromas of any type or one plexiform neurofibroma
–Freckling in the axillary or inguinal regions
–2 or more Lisch nodules (iris hamartomas)
–A distinctive bony lesion such as sphenoid dysplasia or thinning of the long bone cortex
Wednesday, August 3, 2011
A prior post on differentiating the central and peripheral casues of vertigo here. See the bootom for more info on the Eply manuvers.