Prep for USMLEPrep for USMLE Forum
   Forum    Step 1  Step 2 CK Step 2 CS Step 3  Match  IMGs Resources Search






Previous Topic | Next Topic  constrictive heart failure  




Login or Register to post messages 




Author14 Posts
  #1

Which of the following above will be accentuated in constricitve heart failure ?

A. Mitral regurgitation

B. Fall in systemic arterial pressure with inspiration

C. Left Ventricular diastolic pressure

D. CO

F. Ventral wall septal movement




  #2

I think it is B as

The hemodynamic events of constriction in regard to respiratory variation in LV and RV filling are similar to the findings in cardiac tamponade, although the underlying pathological mechanism is different

  #3

need some more answers .......come on guys !


  #4

even i think its b

  #5

F doesn't seem to be clear to me although IVS does start to move toward LV in the beginning of inspiration and to the other on expiration

  #6

C. Left Ventricular diastolic pressure may increase in Constrictive pericarditis.




  #7

It does in diastolic dysfunction

In constrictive physiology, both PCWP and LVEDP decrease on inspiration and almost equalize --> LVEDV decreases --> septum moves toward LV --> increase systemic venous return and filling RV

On expiration, ... the other side

  #8

Does the systemic arterial pressure fall with inspiration ?

Left Ventricle EDP always is elevated in Constrictive heart, also the all -4 chambers pressure are either. Interesting thing is they increase and have the same pressure in all -4 chambers in diastolic.




  #9

[font style="background-color: #33cccc"]Does the systemic arterial pressure fall with inspiration ?[/font]

No, the fall in inspiration is with the venous pressure (Kussmaul's sign)

I would go with C.

I found this from Harrisons which explains the difference with tamponade
The basic physiologic abnormality in patients with chronic constrictive pericarditis is the inability of the ventricles to fill because of the limitations imposed by the rigid, thickened pericardium or the tense pericardial fluid. In constrictive pericarditis, ventricular filling is unimpeded during early diastole but it is reduced abruptly when the elastic limit of the pericardium is reached, while in cardiac tamponade, ventricular filling is impeded throughout diastole. In both conditions, ventricular end-diastolic and stroke volumes are reduced and the end-diastolic pressures in both ventricles and the mean pressures in the atria, pulmonary veins, and systemic veins are all elevated to similar levels, i.e., within 5 mmHg of one another. Despite these hemodynamic changes, myocardial function may be normal or only slightly impaired in chronic constrictive pericarditis. However, the fibrotic process may extend into the myocardium and cause myocardial scarring, and atrophy, and venous congestion may then be due to the combined effects of the pericardial and myocardial lesions.


  #10

wasedf wrote:
[font style="background-color: #33cccc"]Does the systemic arterial pressure fall with inspiration ?[/font]

No, the fall in inspiration is with the venous pressure (Kussmaul's sign)

I would go with C.

I found this from Harrisons which explains the difference with tamponade
The basic physiologic abnormality in patients with chronic constrictive pericarditis is the inability of the ventricles to fill because of the limitations imposed by the rigid, thickened pericardium or the tense pericardial fluid. In constrictive pericarditis, ventricular filling is unimpeded during early diastole but it is reduced abruptly when the elastic limit of the pericardium is reached, while in cardiac tamponade, ventricular filling is impeded throughout diastole. In both conditions, ventricular end-diastolic and stroke volumes are reduced and the end-diastolic pressures in both ventricles and the mean pressures in the atria, pulmonary veins, and systemic veins are all elevated to similar levels, i.e., within 5 mmHg of one another. Despite these hemodynamic changes, myocardial function may be normal or only slightly impaired in chronic constrictive pericarditis. However, the fibrotic process may extend into the myocardium and cause myocardial scarring, and atrophy, and venous congestion may then be due to the combined effects of the pericardial and myocardial lesions.




Agree!


  #11

nodnod Thanks guys

RVEDP and LVEDP equal and elevated with deep and steep y wave (cath) in early diastole

Paradoxical pulse does occur in 1/3 patients with constrictive pericarditis (usually occur in tamponade)

And more ...
... the septum does shift to the LV on inspiration and to the other side on expiration

Edited by ngaybinhyen on 09/11/08 - 09:43 AM

  #12

the answer is B. its in Crush step 2 book review !


  #13

This question has 2 answers B and C , but C happens more common in the context of constrictive pericarditis


  #14

gringrin there should be no more than 1 question about constrictive on the test. I hope they are gonna make it more clear









Login or Register to post messages


















Contact us | Terms & Conditions | Privacy Policy

Copyright @ Prep for USMLE. All rights reserved.