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Lutembacher syndrome
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Kikkeri Hemannasetty Srinivas, Anand Subramaniam
The apex is formed by the right ventricle as it is dilated and the left ventricle is underfilled. A parasternal heave may be present in patients with pulmonary hypertension. Pulsations in the second intercostal space are secondary to an enlarged pulmonary trunk. A systolic thrill is often palpated at the base of the heart at the upper-left sternal border. Prominent pulmonary artery pulsations and basal systolic thrill (and the basal ejection systolic murmur) are due to torrential flow across the right ventricular outflow tract. A diastolic thrill at the apex is uncommon as the mitral flow velocity is low.
Cardiovascular system
Published in Shahed Yousaf, Medical Examination Made Memorable (MEMM), 2018
T Thrills and heaves – a thrill is a palpable murmur. Place examining hand horizontally under the left pectoral, then vertically on the medial side of the left pectoral, then horizontally across centre of ribcage, below sternal notch. Systolic thrill coincides with apex beat. Diastolic thrill does not coincide with apex beat. Parasternal heave may be felt by placing the heel of the hand over the left parasternal region. If a heave is present it should lift the heel of the hand off the chest wall with each systole. Parasternal heaves are due to right ventricular hypertrophy or possibly severe left atrial enlargement pushing the right ventricle forwards.
Cardiovascular system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
= calcification and narrowing of mitral valve → pulmonary hypertension → R. heart failure Causes: rheumatic feverSymptoms: – dyspnoea (increased LA pressure → pulmonary oedema)– haemoptysis– hoarseness (increased LA pressure → impinges on RLN)Signs: – malar flush– L. parasternal heave– increased JVPComplications: – atrial fibrillation– systemic embolisation– pulmonary infarction– RV failureInvestigations: – ECG (bifid P-waves)– CXR (enlarged LA)– echocardiogramManagement: valve replacement
Filarial tropical pulmonary eosinophilia: a condition masquerading asthma, a series of 12 cases
Published in Journal of Asthma, 2019
Wonashi R. Tsanglao, Devki Nandan, Sudha Chandelia, Narendra Kumar Arya, Anu Sharma
On examination, his vitals were stable with SpO2 of 96% at room air. Cardiovascular examination revealed grade 2 left parasternal heave, with palpable P2, single loud S2 and pan-systolic murmur at the left lower sternal edge. Spirometry showed FVC of 85% and FEV1 of 81%, with no significant bronchodilator reversibility (only 7% improvement in FEV1 from baseline 15 minutes after nebulized salbutamol). Chest X-ray revealed prominent pulmonary conus, and ECG showed right axis deviation, P pulmonale and right ventricular strain pattern. On 2D-echocardiography dilated right chambers, severe tricuspid regurgitation (PG=68 mmHg) and moderate pulmonary regurgitation were observed (Figure 1). Blood investigations showed eosinophilia (3.876 × 109 cells/L), serum IgE level of 3760 IU/mL and positive serum filarial antigen. Stool examination was negative for ova and cysts. So a possibility of TPE was considered. Meanwhile, contrast enhanced CT chest (Figure 2a and 2b) revealed centrilobular nodules in bilateral postero-basal segments, mild cardiomegaly with mild dilatation of right ventricle and an enlarged pulmonary artery at its bifurcation. These features were also suggestive of pulmonary embolism but on CT angiography there was no such evidence. Work up for rheumatic heart disease, connective tissue disorders, vasculitis, allergic bronchopulmonary aspergillosis and HIV infection were negative. So he was treated with DEC (300 mg), inhaled bronchodilator and low dose furosemide.