Clinical heart

Question 1

A 45 year old male comes in with sharp chest pain that referred to the neck and supraclavicular shoulder. Why is this?

Answer 1

• Clinical example:*
• Patient experiences referred pain: neck pain or shoulder pain, when they have pericarditis. (C3, C4, C5 phrenic nerve also supply these dermatomes)*

Question 2

Patient complaining of sharp chest pain and jugular venous distends particularly on inspiration. What is this phenomenon called?

Answer 2

• Kussmaul’s sign-JVP distends on inspiration
• constrictive pericarditis prevent heart from pumping blood effectively due to fibrin strands. Normally on inspiration, intrathoracic pressure drops and venous return increases, causing left ventricle to pump blood. However, CP prevents this and causes backflow into JVP

Question 3

Patient comes in with central crushing chest pain and what distinguishes pericarditis from a normal MI?

Answer 3

Pericarditis-is an inflammatory condition of the pericardium. It is hard to distinguish from patients with MI as both present with central chest pain. However, unlike MI, pericarditis may be relieved by sitting up and leaning forward because it reduces pressure on pericardium.

Question 4

How do you remove effusion in pericardial sac?

Answer 4

• Pericardiocentesis-45 degree from xiphoid process