new_n_lost
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A 45 year man with breathlessness is suspected of having chronic constrictive pericarditis. Which one of the following features would be UNEXPECTED?
A. A rise in systolic blood pressure on expiration
B. Pericardial knock
C. Kussmaul's sign
D. Ascites
E. Low pulse pressure
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| Aashi
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A. A rise in systolic blood pressure on expiration
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| mms
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A
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| new_n_lost
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Answer: c) Kussmaul's sign. Expiration may partly relieve pericardial constriction. There is hence a fall in systolic BP on inspiration and rise in expiration.
Pulsus paradoxus (decrease in systolic pressure during inspiration of more than 10mmHg) is rare; it is more typical of cardiac tamponade through the same mechanisms of decreased filling capacity.
The main feature in chronic constrictive pericarditis is restriction of diastolic filling of ventricles. This may lead to the pericardial knock during ventricular filling.
Ascites can occur due to chronic venous congestion and liver cirrhosis. Poor ventricular filling can lead to a low pulse pressure.
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| new_n_lost
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In Chronic Constrictive Pericarditis We will see Systolic Dysfunction but not in Early stages of the Disease.
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| Aashi
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u mean kussmauls sign( a rise in JVP, on inspiration due to impaired RV filling seen in non- complaint pericardium) is NOT seen in constrictive pericarditis??
I agree Kussmauls SIGN is not UNIQUE finding to constrictive pericarditis-->it can be seen in restrictive CM, RV infarction as well..BUT it is ALSO SEEN in constrictive pericarditis..This is NOT AN UNEXPECTED feature..If the q was on cardiac tamponade..yes then u r rt,kussmauls sign is UNEXPECTED---->U may search any source for this info...any other explanations NNL
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| mms
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Hi New-n-lost I don't agree that the answer is C. In constrictive pericarditis there is diastolic disfunction. Kussmaul sign is present.
Kussmaul sign: rise in jugular venous pressure in inspiration due to impaired filling of the right ventricle because of poorly compliant myocardium or poorly compliant PERICARDIUM (-->constrictive pericarditis)
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| new_n_lost
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The Kussmaul sign (ie, elevation of systemic venous pressures with inspiration) is a common nonspecific finding, but this sign is also observed in patients with right ventricular failure, restrictive cardiomyopathy, right ventricular infarction, and tricuspid stenosis, although, importantly, not in patients with cardiac tamponade. Emedicine.
Totally Agreed on this point
But The Explanation provided for the Question says that So NO help there. I m looking into the Causes of it but Rest Assured that Kussmaul's Sign is present in Constrictive Pericarditis n is not Unexpected i m looking into Chronic Condition Pathphysio maybe the answer is there.
Edited by new_n_lost on 03/24/07 - 12:50 PM
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| me007
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funny, i had this concept q yesterday and Kussmaul sign as a specific finding in constrictive pericarditis was the correct ans.
normally- jugular venous pressure decrease with inspiration
in constrictive pericarditis - paradoxal rise bcs of
1. incr in venous return that occur in inspir
2. restriction of heart filling
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| mms
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why is Kussmaul sign not present in patient with cardiac tamponnade?
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| me007
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differential diagnosis for Kussmaul's
cardiac tamponade
restrictive CMP
RHF
tricuspid stenosis.
q is about chronic constrictive pericarditis.
constrictive - fibrous tissue encased the the heart, develops over months-years, it is not early stage according to q., so it will be Kussmaul's sign.
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| new_n_lost
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Guys U arent going to believe How in so many ways a question on Pericarditis can be presented to us So plz bear with me n Read the Whole Article I m sure u will Enjoy it!!!!!!
Attached Files:
Case Presentation of NEJM.doc (52 KB, 9 downloads)
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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