1/11. Utility of hand-carried ultrasound for consultative cardiology.Although the stethoscope has been an important part of the bedside cardiac diagnostic examination for generations of physicians, this clinical tool has been relatively unchanged in over 150 years. echocardiography is established as an essential diagnostic imaging method for patients with known or suspected cardiovascular diseases. However, routine echocardiography systems are large and heavy, and although they are portable, they remain inconvenient for bedside patient rounds. Technologic advances have resulted in miniaturization of electronic components and small, lightweight ultrasound systems have been recently introduced. These hand-carried units offer clinically acceptable two-dimensional image quality for rapid "quick-look" bedside diagnostics, in particular focusing on global and regional left ventricular function and presence or absence of pericardial effusion. This article proposes a general approach to the rapid hand-carried ultrasound cardiac exam as an extension of the physical examination. It details case examples and reviews the initial clinical experience of hand-carried ultrasound on cardiac consultation rounds. hand-carried ultrasound has promise to have an immediate impact on bedside patient management though expediting and facilitating the delivery of medical care.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/11. The many faces of hypothyroidism: a review of two inpatient populations.Unusual presentations of acute hypothyroidism often go unrecognized and delay the onset of effective therapy. We reviewed admissions of two different patient populations at the University of Louisville Hospital and the veterans Affairs Medical Center to evaluate the extent and profiles of such patients admitted for acute care. We found that although these hospitals differed in gender and age profiles, similarities existed for their admissions and delay in diagnosis for hypothyroidism. These similarities were related to unusual clinical presentation including myxedematous states, which were not usually recognized, and psychiatric conditions that were also commonly complicated by hypothyroidism. In all cases, the history, physical examinations, and thyroid-stimulating hormone test were essential in recognizing acute hypothyroidism so as to institute effective therapy with thyroid replacement early in the course of the disorder.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/11. Pericardial conditions: signs, symptoms and electrocardiogram changes.This article describes the anatomy and physiology of the pericardium and the signs and symptoms of acute pericarditis, pericardial effusion and cardiac tamponade. It illustrates the likely electrocardiogram findings in each of these conditions and discusses how the results, combined with patient history and physical examination, can help emergency nurses make accurate diagnoses.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/11. Disseminated pneumococcal infection with pericarditis and cardiac tamponade: report of one case.A 1-year-5-months-old female who had cough, rhinorrhea and prolonged fever for 19 days was admitted to the intensive care unit due to exertional dyspnea. She was intubated promptly in virtue of hypotension and cyanosis. The physical examination demonstrated diminished breathing sound over the right lung and distant heart sound; echocardiogram showed cardiac tamponade. Further X ray study showed right hydropneumothorax and cardiomegaly. pericardiocentesis and chest thoracostomy were performed, and subsequently all the cultures showed growth of streptococcus pneumoniae. Antibiotics therapy was started promptly after admission. Further investigation indicated osteomyelitis of the right ilium, so that surgical debridement was done. The patient was discharged 54 days later with complete recovery. After following up for 18 months, no restrictive heart disease developed. Purulent pericarditis with cardiac tamponade is an extremely rare complication of pneumococcal infection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/11. Perimyocarditis. Report on an unusual cause.A 29-year-old man had a febrile illness accompanied by chest pain and tachycardia. The ECG suggested either myocarditis or acute ischemia. heart muscle enzymes were normal, the peripheral blood count showed absolute and relative lymphocytosis, and an echocardiogram disclosed a small pericardial effusion. After defervescence, splenomegaly was noted and the SGPT level was elevated to four times normal. There was a greater than fourfold rise in titer of IgM antibodies to cytomegalovirus. This is only the second report in detail of perimyocarditis caused by cytomegalovirus mononucleosis. An interesting aspect of the case was an afebrile prodrome that lasted for more than one week, during which prostration, palpitations, and breathlessness on exertion were present and the sole physical finding was tachycardia.- - - - - - - - - - ranking = 0.098812845691526keywords = physical (Clic here for more details about this article) |
6/11. Left ventricular pseudoaneurysm causing superior vena caval obstruction and effusive-constrictive pericarditis.A diabetic woman with a silent myocardial infarction on clinical and electrocardiographic criteria presented with findings on physical examination of superior vena caval obstruction and effusive-constrictive pericarditis. A left ventricular posterior wall pseudoaneurysm and intrapericardial hematoma were found, with extrinsic compression of the right atrium. The diagnosis was first suspected by radionuclide imaging and confirmed by contrast angiography and surgery.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/11. Acute nontraumatic cardiac tamponade.A 33-year-old man presented with acute nontraumatic cardiac tamponade as a result of pneumococcal pericarditis in association with pneumococcal pneumonia. hypotension, tachycardia and pulsus paradoxicus, 50 mm Hg, were present. Echocardiographic findings were compatible with cardiac tamponade. pericardiocentesis was performed. Acute nontraumatic pericardial tamponade in the emergency department presents special problems of diagnosis and management. diagnosis is based on correlation of data from the history, physical examination, electrocardiogram, chest x-ray films, and a high index of suspicion. echocardiography to confirm the diagnosis of tamponade and aid in correct placement of the needle in pericardiocentesis is especially helpful.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/11. Pneumococcal pericarditis: a persisting problem in contemporary diagnosis.We reviewed the clinical and laboratory features of six patients with pericarditis caused by streptococcus pneumoniae who were admitted to boston City Hospital. The diagnosis of pneumococcal pericarditis was delayed or missed entirely during life in all patients. The frequent absence of pericardial friction rubs and cardimegaly on chest roentgenograms contributed to the difficulty in recognizing this illness. Electrocardiograms and physical examinations of the heart almost always disclosed abnormalities, but they were not sufficiently specific to suggest pericarditis, and patients were often thought to have had an acute complication of arteriosclerotic heart disease. review of the English literature since 1945 supports the recent experience in our hospital that the diagnosis of pneumococcal pericarditis may be elusive.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/11. Electrocardiographic manifestations and differential diagnosis of acute pericarditis.Acute pericarditis has many potential etiologies and typically presents as a sharp central chest pain that worsens with recumbency and is relieved by leaning forward. The pathognomonic physical finding of acute pericarditis is the pericardial friction rub, which is usually auscultated along the lower left sternal border. The electrocardiogram (ECG) is a useful, simple tool that may aid in the diagnosis of acute pericarditis. Typical ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression. ECG changes of both acute myocardial infarction and early repolarization can appear similar to ECG changes of acute pericarditis. However, these conditions can usually be excluded by an accurate history, physical examination and recognition of a few key features on the ECG.- - - - - - - - - - ranking = 1.0988128456915keywords = physical examination, physical (Clic here for more details about this article) |
10/11. Rheumatoid pericarditis: comparison of immunologic characteristics of pericardial fluid, synovial fluid, and serum.A comparison was made of the immunological characteristics of serum, synovial and pericardial fluids obtained from a 54 year old man with classic rheumatoid arthritis and pericarditis. The synovial and pericardial fluids had low complement levels and immune complexes were detected using both biological and physical methods. The serum had normal complement levels and no immune complexes could be demonstrated. The presence of immune complexes and complement depletion in the synovial and pericardial fluids supports the concept of local production of immune complexes, and is in keeping with a Type III mechanism of immunologic injury.- - - - - - - - - - ranking = 0.098812845691526keywords = physical (Clic here for more details about this article) |
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