robin082006
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A physician examine a patient and finds a double apical impulse, a double carotid arterial pulse, and a jugular venous pulse that has a prominent "a" wave. The "a" wave change is most immediately related to which of the following
/ A. Diminished left ventricular compliance
/ B. Diminished right ventricular compliance
/ C. Increased compliance of both the right and left ventricles
/ D. Increased left ventricular compliance
/ E. Increased right ventricular compliance
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| linaorvos
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normally I would go with B, since a wave enlargement is due to Tricuspid stenosis, pulm HTN...
but this Q mentioned double carotid arterial pulse...so maybe something is wrong on the left side...
I will choose A....
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| skyhigh
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isn't this E
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| malinda
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prominent A wave whenever there is resistance to right heart filling.so compliance of right heart should decrease.B comes to my mind.Hoenstly I have never heard of double carotid pulse.But if I think hard,I think it is decreased left vent compliance that will produce pulmonary HTN and thus prominent A wave.Then A should be the answer.
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| robin082006
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| msyamp
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hey guys. double apical impulse anddouble carotid pulse is very important sign of the HOCM. LET ME EXPLAIN CLEARLY. what happens in this is. as the ventricle gets filled and starts to contract , initial contction is maximal and contracts strongly to give the first jet and as soon as it contracts forcefully the hypertrophic septum obstructs the orifice and closes it so no jet but as soon as that happens, heart contracts more forcefully and gives second jet.
so this is HOCM. but here. the thing is not double carotid and double apical which is due to LV. it is the problem with JVP which is always RIGHT SIDE . even if it is left problem it shud get reflcted to right to have effect.
now it is the RV non compliance because of hypertrohic septum and ventricle which des not allow the second rapid filling of diastole due to atrial contraction thus pushing the blood not into ventricle but out into JV. so prominent a wave.
so the answer is nonompliant RV so B
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| malinda
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| robin082006
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excellent msyamp
ans is B
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| linaorvos
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THANKS msyamp !
(even if it is left problem it shud get reflcted to right to have effect.) Got the point!
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| linaorvos
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But can we get giant a wave in Mitral Stenosis????
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| msyamp
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no you cant unless you have a tricuspid stenosis or AV dissociation. as MS >> PAH >> RVH. enen RVH cannot cause gaint A wave.
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| linaorvos
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Oh...I got it!! Thank you very much!!!
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| docarchana
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excellent msyamp.
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