China
Africa
Explore chapters and articles related to this topic
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
There is continuous production and resorption of pericardial fluid. If a disease process disturbs this balance a pericardial effusion may develop. If the pressure exceeds the pressure in the atria, compression will occur, venous return will fall and the circulation will be compromised. This state of affairs is called ‘tamponade’. A gradual build-up of fluid (e.g. malignant infiltration) may be well tolerated for a long period before tamponade occurs, and the pericardial cavity may contain 2 litres of fluid. Acute tamponade (from penetrating trauma, during coronary angiography or postoperatively) may occur in minutes with small volumes of blood. The clinical features are low blood pressure with a raised jugular venous pressure and paradoxical pulse. Kussmaul’s sign is a characteristic pattern that is seen when the jugular venous pressure rises with inspiration as a result of the impaired venous return to the heart.
Questions and answers
Published in Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer, Cardiology and the Cardiovascular System on the move, 2015
Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer
(Constrictive pericarditis) Raised JVP, pedal oedema and poor exercise tolerance in this patient suggest cardiac congestion. The lack of previous chest pain and risk factors for ischaemic heart disease makes ischaemia-induced heart failure less likely. A JVP that rises with inspiration is a positive Kussmaul’s sign. Taken together with an insidious onset and possible chest exposure to radiotherapy for breast cancer treatment, this sign is suggestive of constrictive pericarditis. The differential diagnosis for a positive Kussmaul’s sign includes cardiac tamponade and restrictive cardiomyopathy. The presence of normal heart sounds in this case makes cardiac tamponade less likely, although recurrence of malignant disease may present with pericardial effusions (uncommonly).
Neuroanniversary 2022
Published in Journal of the History of the Neurosciences, 2022
Adolph Kußmaul (1822–1902) was a German physician and a leading clinician of his time. He wrote his dissertation under Virchow in Würzburg. He was subsequently professor of medicine at Heidelberg (1857), Erlangen (1859), Freiburg (1859), and Straßburg (1876). During his first year at Heidelberg, he constructed the first ophthalmoscope. He is credited with being the first to describe progressive bulbar palsy and polyarteritis nodosa. He also described the paradoxical rise in jugular venous distension during inspiration seen in constrictive pericarditis (Kussmaul’s sign), and the deep, labored breathing of severe diabetic ketoacidosis (Kussmaul respiration) seen in diabetic coma (Kussmaul coma). He was also the first to describe dyslexia, calling it “word blindness.” His book on aphasia, Die Störungen der Sprache. Versuch einer Pathologie der Sprache Leipzig (1877), was a landmark in its time, and is perhaps his most important contribution.
Multimodality imaging for the diagnosis and treatment of constrictive pericarditis
Published in Expert Review of Cardiovascular Therapy, 2019
Michael Chetrit, Natalie Natalie Szpakowski, Milind Y. Desai
Constrictive pericarditis is caused by a noncompliant pericardial sac which hinders normal cardiac filling during diastole, with a downstream consequence of increased venous congestion and a diminished cardiac index. It involves the dissociation of intracardiac and intrathoracic pressures, resulting in accentuated ventricular interdependence. The recurrent inflammation and fibrosis inherent to constrictive pericarditis can develop from a variety of etiologies, including idiopathic, post-pericardiectomy, radiation, collagen vascular disease, and both purulent and tuberculous infections [1]. Of note, the occurrence of constrictive pericarditis following acute idiopathic pericarditis is rare [2]. The clinical presentation of constrictive pericarditis is a constellation of symptoms related to fluid overload, including elevated jugular venous pressure, ascites, pulsatile liver, pleural effusions, and lower extremity edema. Other findings may include pericardial knock and Kussmaul’s sign.
Adolf Kussmaul (1822–1902), and the naming of “poliomyelitis”
Published in Journal of the History of the Neurosciences, 2022
Nadeem Toodayan, Eric Matteson
In 1873, Kussmaul elucidated what he originally called “pulsus paradoxus” (Kussmaul 1873a) and the associated paradoxical rise of jugular venous pressure on inspiration (Kussmaul’s sign) in four autopsy confirmed cases of constrictive pericarditis (Bilchick and Wise 2002). Applying his expert clinical reasoning skills in 1874 (Kussmaul 1874), he concluded that the “air hunger” in diabetic acetonemia (Kussmaul’s respiration) was caused not by hypoxia but by “chemical disturbances of the body in diabetes” (Minagar and Weiner 2001). These and other such important clinical contributions are widely known to physicians worldwide. The same cannot be said of Kussmaul’s work on poliomyelitis.