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Vascular emergencies
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
These depend on the location of the dissection and whether it tracks proximally or distally: classically a tearing chest pain radiating to the backshockdisparate blood pressures between upper limbsif the dissection tracks proximally it may give rise to a stroke, upper limb ischaemia, MI, aortic regurgitation (new aortic diastolic heart murmur) or cardiac tamponadeif the dissection tracks distally it can cause renal failure or disruption of lower limb arterial inflow.21
Clinical features of mitral stenosis
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Differential diagnosis of a diastolic heart murmur that may mimic MS includes conditions with increased cardiac output states that produce high flow across the mitral valve, which include anemia and pregnancy, post-tricuspid left-to-right shunts like persistent ductus arteriosus and ventricular septal defect and mitral incompetence. Flow murmurs result in mid-diastolic rumble that does not extend beyond mid-diastole and is typically preceded by a third heart sound (S3). Though it can be difficult to differentiate the S3 from an opening snap, S3 is a low-frequency sound, occurring 160 ms or later after A2, whereas OS is a sharp, high-frequency sound occurring less than 120 ms after A2. Severe aortic insufficiency causes functional mitral valve obstruction, compromising the effective mitral orifice as the AR jet impinges on the anterior mitral leaflet (reverse doming of MV in diastole) leading to the Austin-Flint murmur, which can extend into presystole. A simple maneuver like isometric handgrip, which increases the aortic incompetence, accentuates the Austin Flint murmur, while MS murmur is not appreciably altered by this maneuver.
Case 36: Fever, Weight Loss and Night Sweats
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Infective endocarditis has to be high up on the list of differential diagnoses. The patient describes fevers, weight loss and night sweats and he has a diastolic heart murmur. While he has no obvious risk factors for infective endocarditis, such as intravenous drug use or recent dental surgery, this would provide a unifying diagnosis for his symptoms. Metastatic abscess formation or septic emboli could explain his spinal and right upper quadrant abdominal tenderness. Septic emboli could have caused pulmonary infarction and the subsequent development of a reactive pleural effusion. Splenomegaly would explain the left upper quadrant abdominal tenderness.
Giant dissecting aortic aneurysm in a chronic amphetamine user
Published in Acta Cardiologica, 2019
Katrien Van Kolen, Jerrold Spapen, Marc Vaerenberg
A 50-year-old woman with a history of chronic amphetamine abuse was referred for cardiac evaluation because of a newly diagnosed loud diastolic heart murmur and decreasing physical performance. She had no other relevant medical or familial history, did not smoke and took no chronic medication. Transthoracic echocardiography revealed aneurysmal enlargement of the ascending aorta with a clear dissection flap (Figure 1(A), arrows) that impaired a tricuspid aortic valve leading to severe regurgitation. The left ventricle appeared dilated without regional wall motion abnormalities. Estimated left ventricular ejection fraction was 50%. The mediastinal widening initially noticed on chest X-ray (Figure 1(B), arrows) was identified on computed tomography as a 10 cm diameter aortic aneurysm with dissection involving the ascending aorta, aortic arch and descending aorta terminating above the origin of the renal arteries (Figure 1(C,D), arrows). The left subclavian and superior mesenteric arteries were involved, yet signs of ischaemia were absent. A diagnostic work-up to exclude underlying genetic or connective tissue disease was rejected by the patient. She was scheduled for urgent surgical repair but refused treatment and became lost to follow-up.