| 09/11/08 - 09:07 AM  
 
|   #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!
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| ngaybinhyen Forum Guru
Topics: 23 Posts: 657
| | 09/11/08 - 09:30 AM  
 
|   #11 |
 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
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| DrAlex_76 Forum Guru
Topics: 120 Posts: 410
| | 09/18/08 - 10:51 AM  
 
|   #12 |
the answer is B. its in Crush step 2 book review !
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| nightflight1945 banned
Topics: 32 Posts: 920
| | 09/18/08 - 11:35 AM  
 
|   #13 |
This question has 2 answers B and C , but C happens more common in the context of constrictive pericarditis
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| ngaybinhyen Forum Guru
Topics: 23 Posts: 657
| | 09/18/08 - 11:04 PM  
 
|   #14 |
 there should be no more than 1 question about constrictive on the test. I hope they are gonna make it more clear
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