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How would you treat a patient with constrictive pericarditis ?

How would you treat a patient with constrictive pericarditis ?  • Surgery is the only satisfactory treatment: Complete surgical resection of the pericardium (myocardial inflammation or fibrosis may delay symptomatic response). Patients with tuberculous pericarditis should be pre-treated with antituberculosis therapy; if the diagnosis is confirmed after pericardial resection, full anti-tuberculous therapy should be continued for 6-12 months after resection. C.S. Beck (1894-1971), surgeon, Peter Bent Brigham Hospital in Boston. W. Broadbent(1868-1951), English physician who qualified from St Mary's Hospital Medical School, London. He described the Broadbent sign in constrictive pericarditis, which is an indrawing of the 11th and 12th left ribs with a narrowing and retraction of the intercostal space posteriorly; this occurs as a result of pericardial adhesions to the diaphragm.

How would you investigate a patient with constrictive pericarditis ?

How would you investigate a patient with constrictive pericarditis ?  • Chest radiograph typically shows normal heart size and pericardial calcification (note: the combination of pulsus paradoxus, pericardial knock and pericardial calcification favours the diagnosis of constrictive pericarditis). • ECG shows low voltage complexes, non-specific T wave flattening or atrial fibrillation. • Echocardiogram shows myocardial thickness is normal and may reveal thickened pericardium; normal ventricular dimensions with enlarged atria and good systolic and poor diastolic dysfunction.  Doppler shows increased right ventricular systolic and decreased left ventricular systolic velocity with inspiration, expiratory aug-mentation of hepatic vein diastolic flow reversal. • CT scan or MRI: shows normal myocardial thickness usually, and pericardial thickening and calcification. • Cardiac catheterization typically shows identical left and right ventricular filling pressures and pulmonary artery

Mention some causes of constrictive pericarditis.

Mention some causes of constrictive pericarditis. • Tuberculosis (<15% of patients). • Connective tissue disorder. • Neoplastic infiltration. • Radiation therapy (often years earlier). • Postpurulent pericariditis. • Haemopericardium after surgery (rare). • Chronic renal failure.

What do you know about Takayasu's arteritis ?

What do you know about Takayasu's arteritis ?  It tends to affect young women and most of' the cases have been h'om Japan. Prodromal systemic symptoms include fever, night sweats, anorexia, weight loss, malaise, fatigue, arthralgia and pleuritic pain. It predominantly involves the aorta and is of three types: Type I (Shimizu-Sano) which involves primarily the aortic arch and brachiocephalic vessels; Type II (Kimoto) which affects the thoraco-abdominal aorta and particularly the renal arteries; Type III (Inada) with features of Types I and II. Types I and III may be complicated by aortic regurgitation. { M. Takayasu (1860-1938), Japanese ophthalmologist.

What are the causes of differences in blood pressure between arms or between the arms and legs ?

What are the causes of differences in blood pressure between arms or between the arms and legs ?   • Occlusion or stenosis of the artery of ally cause. • Coarctation of the aorta. • Dissecting aortic aneurysm. • Patent ductus arteriosus. • Suprava!vu!ar aortic stenosis. • Thoracic outlet syndrome.

What are the causes of absent radial pulse ?

What are the causes of absent radial pulse ? • Aberrant radial artery or congenital anomaly (check the brachials and blood pressure). • Artery tied off at surgery or previous surgical cut-down. • Catheterization of the brachial artery with poor technique. • Following a radial artery line for monitoring of blood gases or arterial pressure. • Subclavian artery stenosis. • Blalock-Taussig shunt on that side (shunt from subclavian to pulmonary artery). • Embolism into the radial artery (usually due to atrial fibrillation). • Takayasu's arteritis (rare).

In which conditions may the pulse rate in one arm differ from that in the other ?

In which conditions may the pulse rate in one arm differ from that in the other ?  Usually, slowing of the pulse on one side occurs distal to the aneurysmal sac. Thus, an aneurysm of the transverse or descending aortic arch causes a retardation of the left radial pulse. Also, the artery feels smaller and is more easily compressed than usual. An aneurysm of the ascending aorta or common carotid artery may result in similar changes in the right radial pulse.

What do you know about the raussig-Bing syndrome ?

What do you know about the raussig-Bing syndrome ?  In this condition the aorta arises from the right ventricle; the pulmonary trunk overrides both ventricles at the site of an interventricular septal defect.  Etienne-Louis Arthur Fallot (1850-1911), Professor of Hygiene and Legal Medicine in Marseilles, published his Contribution to the pathologic anatomy of morbus coeruleus cardiac cyanosis in 1888. The tetralogy was first described by N. Stensen, Professor of Anatomy in Copenhagen, in 1672 (Fallot A. Contribution a I'anatomie pathologique de la maladie bleue (cyanose cardiaque). Marseille Medical 1888; 25: 418-20). Helen Brook Taussig (1898-1986) is the founder of American paediatric cardiology. She collaborated with Alfred Blalock (1899-1964), a vascular surgeon, in the development of palliative surgery for Fallot's tetralogy (JAMA 1945; 128: 189).

What is the treatment for Fallot's tetralogy ?

What is the treatment for Fallot's tetralogy ? • Total correction under the age of 1 year when there is no need for an outflow transannular patch. A second-stage total correction can be performed when the child is over the age of 2 years. • Blalock-Taussig shunting is performed nowadays only if the anatomy is unfavourable for a total correction. • Modified Blalock-Taussig shunting is the interposition of a tubular graft between the subclavian and pulmonary arteries. • The Waterston shunt involves anastomosis of the back of the ascending aorta to the pulmonary artery. A Waterston shunt is performed when surgery is required under the age of 3 months because the subclavian artery is too small for a good Blalock-Taussig shunt. • The Potts shunt involves anastomosis of the descending aorta to the back of the pulmonary artery (JAMA1946; 132: 627). • The Glenn operation involves anastomosis of the superior vena cava to the right pulmonary artery. The bidirectional Glenn procedure i

What do you know about the embryological development of Fallot's tetralogy ?

What do you know about the embryological development of Fallot's tetralogy ?  It arises from the anterior displacement of the canal septum, which leads to unequal partitioning of the conus at the expense of the right ventricular infundibulum and results in the obstruction of the right ventricular outflow tract and failure to close the intraventricular foramen.

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