CARDIOVASCULAR SYSTEMppt.pptx

They may occur either regularly or irregularly and

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THEY MAY OCCUR EITHER REGULARLY OR IRREGULARLY AND ARE MOST COMMON IN THE PRESENCE OF ARRHYTHMIAS. REGULARLY - DURING JUNCTIONAL RHYTHM. IRREGULARLY – 1. ATRIOVENTRICULAR DISSOCIATION WITH VENTRICULAR TACHYCARDIA. 2. COMPLETE HEART BLOCK. •. ABSENT 'A' WAVE - ATRIAL FIBRILLATION 45
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7 46
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HEPATOJUGULAR REFLUX OR ABDOMINOJUGULAR REFLEX THIS IS DONE BY APPLYING FIRM PRESSURE WITH THE PALM OF THE HAND TO THE RIGHT UPPER QUADRANT OF THE ABDOMEN FOR 10-15 SECONDS WITH THE PATIENTS BREATHING QUIETLY WHILE THE JUGULAR VEIN IS OBSERVED. 47
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IN NORMAL SUBJECTS (NEGATIVE HEPATO JUGULAR REFLUX). JUGULAR VENOUS PRESSURE RISES ONLY TRANSIENTLY WITH RAPID RETURN TO THE BASELINE. POSITIVE HEPATOJUGULAR REFLUX (RT. VENTRICULAR FAILURE). A POSITIVE ABDOMINOJUGULAR REFLUX SIGN IS DEFINED BY AN INCREASE IN THE JUGULAR VENOUS PRESSURE OF GREATER THAN 3 CM, SUSTAINED FOR GREATER THAN 15 SECONDS. 48
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57 49
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CONDITIONS ASSOCIATED WITH ABDOMINOJUGULAR REFLUX – LEFT VENTRICULAR FAILURE RIGHT HEART FAILURE CONSTRICTIVE PERICARDITIS RIGHT VENTRICULAR INFARCTION RESTRICTIVE CARDIOMYOPATHY 50
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51 Ans. is 'b' i.e., Associated with decreased afterload [Ref CMDT2007p. 318; British MedicalJournalMay 1999] Note - Both pulmonary stenosis and tricuspid regurgitation cause right heart failure.
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52
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CAUSES OF ELEVATED JVP 1. UNILATERAL NON-PULSATILE  INNOMINATE VEIN THROMBOSIS 2. BILATERAL NON-PULSATILE SVC OBSTRUCTION MASSIVE RIGHT SIDED PLEURAL EFFUSION 53
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3. BILATERAL PULSATILE A. CARDIAC 1. CARDIAC FAILURE 2. TRICUSPID STENOSIS 3. TRICUSPID REGURGITATION 4. CONSTRICTIVE PERICARDITIS 5. CARDIAC TAMPONADE •. B. PULMONARY COPD/COR PULMONALE •. C. ABDOMINAL  ASCITES PREGNANCY •. D. IATROGENIC  EXCESS IV FLUIDS 54
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CAUSES OF FALL IN JVP :- HYPOVOLEMIA SHOCK ADDISON’S DISEASE. 55
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HEART SOUNDS 56
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RIGHT OFTHE STERNUM (ALONG RIGHT UPPER STERNAL BORDER). PULMONIC AREA — SECOND INTERCOSTAL SPACE TO THE LEFT OF THE STERNUM (ALONG LEFT UPPER STERNAL BORDER) ERB'SPOINT — THIRD INTERCOSTAL TO THE LEFT OF THE STERNUM (ALONG LEFT STERNAL BORDER). TRICUSPID AREA —P FOURTH OR FIFTH INTERCOSTAL SPACE TO THE LEFT OF THE STERNUM (ALONG LEFT LOWER STERNAL BORDER). MITRAL AREA (APEX) — FIFTH INTERCOSTAL SPACE ON THE LEFT 57
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HEART SOUNDS FIRST HEART SOUND (S1) "S1 IS HEARD DUE TO CLOSURE OF AV VALVES“. 58
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59
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60 Ans. is 'a' i.e., Short PR interval . [Ref. Harrison 18th/ep. 1825, 1826 & 17"/e p. 1385] Explanation of the loud S in short PR interval PR interval denotes the time interval between atrial and ventricular contraction. PR interval occurs due to delay at the A.V. node. This delay allows maximal time for atrial contraction and protects the ventricle from fast stimulation.
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10 61 Ans. is 'c' i.e., Short PR interval; 'd' Tachycardia [Ref: Harrison 18th/ep. 1825,1826& 1711ep. 1385]
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SECOND HEART SOUND (S2) DUE TO CLOSURE OF SEMILUNAR VALVES.
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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