By Donald N. Ross B.Sc., M.B., Ch.B., F.R.C.S. (auth.)

ISBN-10: 354002901X

ISBN-13: 9783540029014

ISBN-10: 3642854826

ISBN-13: 9783642854828

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Additional info for A Surgeons’Guide to Cardiac Diagnosis: Part 1: The Diagnostic Approach

Example text

For example, in aortic stenosis tbe pulse may bave a slow rise and a sustained "plateau" cbaracter. "'". I I I I : . I Normo/ ; f'. • \ \ \, . "\ ~ .. \. Aorlic Stenosis Fig. 25. Figures show the normaJ pulse contour and the alterations brought about by aortic stenosis In examining tbe pulses it is important to examine as many as possible, certainly botb radial and botb femoral pulses. In tbis way a diagnosis of coarctation of tbe aorta can be made immediately. In a man witb absent femoral pulses one sbould next feel for tbe aortic pulse in tbe epigastrium.

It is, therefore, absent in atrial fibrillation. The c wave. There has been a good deal of controversy regarding the C wave, so-called because it is co-incident with the carotid pulse and, therefore, synchronous with ventricular systole. It is not, only, due to the carotid pulse in the neck, as can be demonstrated by its presence in cardiac catheterization pressures recorded from the right atrium. One explanation is that it arises from a billowing of the tricuspid valve cusps into the atrium. This is brought about by the rise of ventricular pressure during systole.

In addition to the heart sounds already described, a number of extra sounds may be audible. The best known of these are the "opening snap" of the mitral valve and the pulmonary and aortic ejection sounds or clicks. These can all be conveniently regarded (for the purposes of surgical assessment), as representing "opening snaps" emanating from the mitral, pulmonary and aortic (' ~' \""'---"'"~- - - - - . 1. ,... , 1 2 'os.. G. _ _ _ _ _ _ _ _--... ~ 1 Fig. 46 . ) is most clearly audible media! to the apex.

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A Surgeons’Guide to Cardiac Diagnosis: Part 1: The Diagnostic Approach by Donald N. Ross B.Sc., M.B., Ch.B., F.R.C.S. (auth.)


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