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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Female patients often have atypical chest discomfort, and older patients may have more dyspnea than ischemic-related chest pain. If there is severe ischemia, the pain may be extreme and the patient becomes apprehensive and restless. Nausea and vomiting are more common with inferior MI. For some patients, the primary symptoms are dyspnea and weakness (from LV failure), pulmonary edema, significant arrhythmia, and shock. The patient’s skin may be moist, pale, and cool, and peripheral or central cyanosis may be seen. Blood pressure can be varied, but many patients first experience early hypertension when the pain manifests. The pulse is often described as thready. Heart sounds are often slightly distant, and a fourth heart sound is nearly always present. In some cases, there is a soft systolic blowing apical murmur, which indicates dysfunction of the papillary muscle of the heart. Upon first examination, a preexisting heart condition or another type of condition may be suggested by a friction rub or more significant murmurs. If a friction rub is found within several hours after MI symptoms begin, acute pericarditis is more likely than MI. Even so, friction rubs described usually as evanescent. In about 15% of patients, the chest wall is tender when it is palpated. Signs of RV infarction include distended jugular veins, often with the Kussmaul sign, elevated RV filling pressure, lung fields that are clear, and hypotension.
Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
In severe aortic stenosis the pulse amplitude is low and there is left ventricular enlargement. A prominent fourth heart sound is audible. There is no difference between the radial and femoral pulses and the jugular venous pulse is normal.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
A fourth heart sound is also a low-frequency sound. It is best heard immediately before the first heart sound and signifies that atrial systole is abnormally forceful. The presence of an atrial (fourth) sound implies that the end-diastolic pressure is raised in the ventricle concerned, for example in the left ventricle in systemic hypertension.
Evolution of out-of-hospital emergency cardiac care: Heart attack therapy for a retired president helped modernize American emergency medical services
Published in Baylor University Medical Center Proceedings, 2019
Nathaniel P. Rogers, Richard S. Crampton
Our wee hours, predawn team included C-ARS EMTs Lynwood McCauley and John R. Miles, also a medical student; as well as Dr. Robert Harris; Deaton Smith, a third-year medical student; and myself. We found President Johnson sweating profusely with chest pain radiating to the left shoulder and neck. When chest pain had awakened him at 2:30 am, he took an antacid and six sublingual nitroglycerin tablets without relief. Examination disclosed a blood pressure of 165/90 mm Hg, no jugular vein distention, a regular heart rhythm with premature beats, a forceful apex beat, a loud fourth heart sound, a single second sound, no murmur, no friction rub, and rales at both lung bases. He quickly responded to our intravenous morphine 4 mg injection and oxygen by mask. Next, intravenous lidocaine 100 mg abolished his R on T early coupled ventricular premature beats. His 12-lead ECG showed anterior Q waves with ST segment elevation indicative of acute anterior myocardial infarction (Figure 2). On the spot, LBJ’s wife Lady Bird wisely phoned Dr. J. Willis Hurst of Atlanta so that we could discuss LBJ’s cardiac history. Hurst had cared for LBJ during his 1955 heart attack and recalled it as inferior infarction. Thus, we both realized that LBJ had a new site of acute infarction.