By Atul Luthra

This publication presents postgraduate trainees with 50 actual medical cardiology situations. Divided into fourteen sections, numerous situations are offered lower than every one type masking a number of issues of the cardiac method, together with congenital middle illnesses, aortic valve ailments, pulmonary illnesses, ECG abnormalities, cardiac arrhythmias, coronary artery affliction and lots more and plenty extra. starting with a short historical past and findings in response to actual exam, every one case then comprises analytical dialogue on bedside investigations and suggestions for remedy. Authored by way of a regarded specialist within the box, this useful ebook is very illustrated with echocardiographic, radiographic and electrocardiographic info. Key issues * offers 50 genuine scientific cardiology circumstances * Covers a variety of issues of the cardiac process * Authored through known heart specialist * contains greater than 217 pictures, illustrations and tables

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There may also be reverse splitting of S2, due to delayed closure of the aortic valve. When pulmonary hypertension develops, the murmur of PDA is confined to systole. As already mentioned, there are several causes of a continuous murmur. In aorto-pulmonary window, there is a proximal communication between the aorta and the pulmonary artery. Although the murmur of aortic coarctation is typically systolic, in tight stenosis the murmur may extend into diastole. Venous hum is a low-pitched continuous murmur which is loudest over the supraclavicular fossa, but sometimes also heard over the precordium.

The most likely diagnosis in this case is mitral valve prolapse (MVP). The mid-systolic click is a high-pitched sharp sound produced by sudden tensing of the redundant mitral leaflet. At times, multiple clicks are appreciated. This is often followed by a mid- or late-systolic murmur that typically has a whooping or honking character. 34 Section 2 Mitral Valve Diseases Another cause of a mid-systolic murmur is papillary muscle dysfunction. The click and murmur can vary with alteration of left ventricular (LV) volume, by change in patient posture.

Also, presystolic accentuation is lost due to lack of atrial contribution to ventricular filling. Presystolic accentuation is also absent in a calcified valve and after commissurotomy. Severe mitral stenosis may be silent due to low cardiac output and the fact that the right ventricle underlies most of the precordium because of clockwise cardiac rotation. The opening snap heralds the onset of ventricular diastolic filling and the end of isovolumic relaxation. It indicates pliability of the valve, suitability for valvotomy and is absent in a heavily calcified valve or after commissurotomy.

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