Figure below is a schematic illustration of carotid pulse.
Match the diagnosis with the pulse.
Hypertrophic cardiomyopathy. This can also be characterized by a bisferiens carotid pulse with rapid fall in first wave with rapid rise of the second.
Severe CHF decompensation. Demonstrates the dicrotic pulse which can occur in diastole in patients with low stroke volume being ejected. This can occur in severe heart failure, cardiac tamponade, and hypovolemic shock.
During physical examination, you notice an elevated systemic venous pressure with sharp y-descent Kussmaul sign and quiet pericardium. What might the patient have?
Constrictive pericarditis. The high initial venous wave (a wave) is characteristic of atrial contraction. The rapid y descent is suggestive of rapid ventricular filling.
During another physical examination, you notice a prominent v wave with a sharp y descent. What condition does the patient have?
Tricuspid regurgitation. The v wave is a reflection of ventricular contraction and the pressure that is transmitted back to the atrium from a tricuspid valve that pushes back into the atrium. In the tricuspid regurgitation, there is increased pressure during ventricular systole.
Again you notice an elevated systemic venous pressure without obvious x or y descent and quiet precordium and pulsus paradoxus.
What does the patient have?
Tamponade. There is constant pressure from the pericardium that does not allow for atrial relaxation so the y descent is blunted.
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