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Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
RV failure is signified by foot and ankle nontender peripheral pitting edema, in which pressure by the examiner’s fingers leaves imprints that are visible and palpable, and may be very deep. The liver is enlarged and may be pulsatile, and is palpable below the right costal margin. Abdominal swelling and ascites develop. The jugular venous pressure is elevated. An increased jugular venous pressure during inspiration is known as the Kussmaul sign, which indicating right-sided HF. If the liver is congested, it may be enlarged or tender. Hepatojugular or abdominal-jugular reflux may be present. Auscultation can detect murmur of tricuspid regurgitation or the RV third heart sound of the left sternal border. These findings are both changes during inspiration.
Pre-Hospital and Emergency Trauma Care
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Tension pneumothorax is diagnosed clinically with deviation of the trachea away from the lesion (a late sign), hypertympany on the side of the lesion, and decreased breath sounds on the affected side. There is usually associated elevated jugular venous pressure in the neck veins, unless the patient is hypovolaemic. This is a clinical diagnosis, and once made, an immediate needle thoracostomy or tube thoracostomy should be performed to relieve the tension pneumothorax. The tube should then be placed to underwater seal.
Heart disease in the elderly
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Isolated systolic hypertension with associated visible carotid artery and brachial artery pulsation is common. Systolic murmurs may be due to aortic valve thickening (‘aortic sclerosis’), aortic stenosis or mitral regurgitation. A third heart sound due to a stiff, non-compliant left ventricle, and a fourth heart sound due to heart failure, are not uncommon in the elderly. It may be difficult to measure the jugular venous pressure because of tethering of the overlying skin and subcutaneous fascia. Elderly, immobile patients who sit for long periods may have swollen feet and ankles. This ‘postural oedema’ needs to be distinguished from venous hypertension due to right heart failure.
Management of fluid status and cardiovascular function in patients with diffuse skin inflammation
Published in Journal of Dermatological Treatment, 2019
Arash Taheri, Amanda D. Mansouri, Parisa Mansoori, Rahimullah Imran Asad
Acute respiratory distress syndrome should be a differential diagnosis of cardiogenic pulmonary edema in patients with widespread skin inflammation, especially erythrodermic psoriasis (20–23). Acute respiratory distress syndrome is a form of diffuse alveolar injury and is not secondary to increased intravascular volume or heart failure. Clinically, jugular venous pressure is not high in these patients. This syndrome is much rarer than cardiogenic pulmonary edema in general and in patients with erythroderma specifically. Although such patients do not respond to diuresis as well as patients with cardiogenic pulmonary edema, they are very sensitive to increased pulmonary vascular pressure and may worsen rapidly if there is rapid migration of fluid into the intravascular space (24–26). Treatment of these patients should be started as soon as possible in an intensive care unit with possible intubation and mechanical ventilation.
Hydralazine-induced pericardial effusion
Published in Baylor University Medical Center Proceedings, 2019
Mohammed Faisal Rahman, Muhammad Ajmal Panezai, Harold M. Szerlip
His blood pressure was 114/62 mm Hg; pulse, 79 beats/min; respiratory rate, 20 breaths/min; temperature, 97.5°F; and oxygen saturation, 100% in ambient air. The lungs were clear to auscultation. His jugular venous pressure was estimated to be 8 to 10 cm H2O. His heart sounds were audible, with prominent S4 and no murmur. The liver was extended 4 to 5 cm below the right costal margin. There was 1+/4+ lower-extremity edema. The hemoglobin was 7 mg/dL (from a baseline of 9 mg/dL); blood urea nitrogen, 61 mg/dL; creatinine, 8.6 mg/dL; total bilirubin, 1.7 mg/dL; alkaline phosphatase, 278 mg/dL; albumin, 2.9 g/dL; total protein, 7.2 g/dL; serum iron, 59 μg/dL; percent saturation, 44%; ferritin, 2300 ng/mL; and thyroid-stimulating hormone, 1.24 IU/mL. White cell and platelet counts, serum electrolytes, and transaminases were normal, and troponin, serum markers for hepatitis B and hepatitis C infection, and interferon gamma release assay were negative. The erythrocyte sedimentation rate was significantly elevated at 140 mm/h. Antihistone antibody was positive, but ANA was negative. Other autoantibodies were not checked due to negative ANA. Chest x-ray showed an enlarged cardiac silhouette (Figure 1a). Transthoracic echocardiography revealed an ejection fraction of 65% and a large circumferential pericardial effusion without evidence of tamponade (Figure 1b).
Clinical pearls in hospital nephrology
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abdurrahman Hamadah, Tibor Fulop, Kamel Gharaibeh
A 61-year-old woman is admitted to the hospital with a one-week history of worsening lower extremity edema, dyspnea, and orthopnea. She has PMH of hypertension, CKD stage 3, and heart failure (ejection fraction (EF) 35%). Her blood pressure (BP) is 112/62 mmHg, heart rate (HR) is 98 bpm, and respiratory rate (RR) is 24 bpm. Her examination is remarkable for increased jugular venous pressure, bibasilar crackles, and peripheral pitting edema. Her medications include losartan 50 mg daily, metoprolol 25 mg daily, and furosemide 20 mg daily. Initial laboratory investigation showed a serum sodium of 139 mEq/L, potassium of 5.2 mEq/L, and creatinine of 1.6 mg/dl.