CARDIOVASCULAR SYSTEMppt.pptx

Ii the second phase of increase in diastolic pressure

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II) THE SECOND PHASE OF INCREASE IN DIASTOLIC PRESSURE DUE TO RAPID FILLING OF THE VENTRICLE, FOLLOWING, THE OPENING OF THE A-V VALVE. THIS PHASE OF RAPID VENTRICULAR FILLING IS UNRESTRAINED IN CONSTRICTIVE PERICARDITIS SO THERE IS MORE THAN THE NORMAL INCREASE IN DIASTOLIC PRESSURE. 232
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THE THIRD PHASE OR THE PLATEAU PHASE:- IN THIS PHASE THE RIGID PERICARDIUM ABRUPTLY HALTS THE RAPID FILLING OF THE VENTRICLES, WHEN THEY REACH THE MAXIMUM CARDIAC VOLUME ALLOWED BY IT. THIS IS ATTAINED NEAR THE END OF THE FIRST THIRD OF DIASTOLE . AFTER THIS THERE IS NO FURTHER INCREASE IN VENTRICULAR DIASTOLIC PRESSURE (I.E. IT PLATEAU'S OFF). WHEN THIS VENTRICULAR DIASTOLIC PRESSURE IS PLOTTED ON A GRAPH, A SQUARE ROOT SIGN IS OBTAINED 233
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Q- C/F-CONSTRITIVE PERICARDITIS 234
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CONSTRICTIVE PERICARDITIS IS CHARACTERIZED BY ABNORMALLY RAPID VENTRICULAR FILLING DURING FIRST ONE THIRD OF THE DIASTOLE. THIS RAPID VENTRICULAR FILLING IS SUDDENLY HALTED BY THE FIBROTIC AND THICKENED PERICARDIUM. THE VENTRICULAR FILLING STOPS ABRUPTLY. THE SUDDEN CESSATION OF BLOOD FLOW PRODUCES PERICARDIAL KNOCK. (AN EARLY DIASTOLIC SOUND THAT IS OFTEN HEARD ALONG THE LEFT STERNAL BORDER FOLLOWING S2). IT OCCURS EARLIER THAN S3 AND IT HAS HIGHER ACOUSTIC FREQUENCY THAN S3 . 235
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IN CONSTRICTIVE PERICARDITIS DUE TO CONSTRICTING EFFECT OF THE PERICARDIUM THE CARDIAC FILLING IS IMPAIRED. THE FILLING PRESSURE IS RAISED. SO THE VENOUS PRESSURE MUST BE INCREASED TO INCREASE THE FILLING. THE SYMPTOMS AND SIGNS OF CONSTRICTIVE PERICARDITIS RESULTS DUE TO INCREASE IN VENOUS PRESSURE. 236
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SIGNS AND SYMPTOMS OF CONSTRICTIVE PERICARDITIS: 1) ELEVATED SYSTEMIC VENOUS PRESSURE:- JUGULAR VENOUS DISTENSION, HEPATOMEGALY WITH MARKED ASCITES AND PERIPHERAL EDEMA. THE MOST CONSISTENT FINDING OF CONSTRICTIVE PERICARDITIS IS THE INSIDUOUS DEVELOPMENT OF ASCITES OF HEPATOMEGALY. 2) REDUCED CARDIAC OUTPUT:- FATIGUE, HYPOTENSION, REFLEX TACHYCARDIA. 237
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ACUTE LEFT VENTRICULAR FAILURE RESULTING IN ACUTE PULMONARY EDEMA IS RARE IN CONSTRICTIVE PERICARDITIS. THE APICAL PULSE IS REDUCED AND RETRACTS IN SYSTOLE (TAPPING APEX) . (BROAD BENT'S SIGN). 238
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Q- C/F-CONSTRITIVE PERICARDITIS 239 A
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240
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CLINICAL FEATURES OF CHRONIC CONSTRICTIVE PERICARDITIS: DECREASE IN VENTRICULAR END DIASTOLIC VOLUME. DECREASE IN STROKE VOLUME. INCREASE IN END DIASTOLIC PRESSURE IN BOTH VENTRICLES. INCREASE IN MEAN PRESSURE IN ATRIA, PULMONARY VEINS AND SYSTEMIC VEINS. CONGESTIVE HEPATOMEGALY. ASCITES. KUSSUMAUL SIGN IS PRESENT. 241
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IN THE PAST TUBERCULOSIS WAS THE MOST COMMON CAUSE OF CONSTRICTIVE PERICARDITIS, BUT NOW IT IS MORE OFTEN DUE TO : RADIATION THERAPY, CARDIAC SURGERY OR VIRAL PERICARDITIS. 242
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243
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244 C
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245
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CAUSES OF HAEMORRHAGIC PERICARDITIS:- 1) TUBERCULOSIS 2) MALIGNANT INVOLVEMENT OF PERICARDIAL SAC 3) BLEEDING DIATHESIS 4) CARDIAC SURGERY 5) POST MYOCARDIAL INFARCTION 6) DISSECTING ANEURYSM OF AORTA 7) UREMIC PERICARDITIS 246
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247
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AUENBRUGER'S SIGN IS AN EPICARDIAL BULGING DUE TO MASSIVE PERICARDIAL EFFUSION.
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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