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Is there a murmur? Cardiomegaly with cardiac murmurs suggests valvular disease, but it also suggests congestive heart failure and advanced myocardiopathies. One should also be sure that the murmur is not a pericardial ... DIAGNOSTIC WORKUP
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Cardiomegaly is defined as enlargement of the heart above the normal size. When looking at a chest X-ray, one must be sure that an anterior-posterior view is being used, because the heart may appear falsely enlarged on a posterior-anterior view. When true... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Paroxysmal nocturnal dyspnea is defined as severe difficulty breathing or air hunger that awakens the patient from sleep (usually 1–3 hours after lying down) and forces them to a sitting or standing position. The patient may gasp and proceed to an open window... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Heart failure exists when adequate cardiac output cannot be maintained either at rest or with activity. It can be either acute, chronic, or an acute decompensation of the chronic state, and represents a wide range of anatomic and pathophysiologic conditions. The three... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... If an x-ray film demonstrates cardiomegaly, the physician must find out what is causing this condition ( Table 13 ). You have already listened to the patient and he or she does not have a murmur. This seems to exclude the common groups of causes
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... Typically dramatic and terrifying to the patient, this sign refers to an attack of dyspnea that abruptly awakens the patient. Common findings include diaphoresis, coughing, wheezing, and chest discomfort. The attack abates after the patient... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed pressure — a difference of less than 30 mm Hg —... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Left Heart Failure
Hypertensive heart disease
Coronary artery disease
Left ventricular diastolic dysfunction
Acute myocardial infarction
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... Signs and Symptoms Left-sided: dyspnea, orthopnea, crackles, wheezing, hypoxia, respiratory acidosis, cough, cyanosis, palpitations, arrhythmias, elevated blood pressure, pulsus alternans; right-sided: dependent peripheral edema, hepatomegaly, splenomegaly, jugular... Treatment (Tx) ... Pictures
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... Typically dramatic and terrifying to the patient, this sign refers to an attack of dyspnea that abruptly awakens the patient. Common findings include diaphoresis, coughing, wheezing, and chest discomfort. The attack abates after the patient sits up or... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed pressure—a difference of less than 30 mm... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... John Coe and Ron Sand
Cardiomegaly is a common, nonspecific finding that can be detected by physical examination, electrocardiogram (ECG), chest radiograph, or echocardiogram. With rare exceptions, it is a sign of organic heart disease. The... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Anthony F. Jerant
Congestive heart failure (CHF) is the most frequent reason for hospitalization among older adults in the United States. Nearly one-third of a national cohort of 170,239 Medicare enrollees hospitalized for the first time with CHF died within a... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Congestive heart failure
❑ Hypertensive left ventricular hypertrophy
❑ Anterior myocardial ischemia ... Diagnostic Approach ... Clinical Findings ... Pictures
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... A syndrome characterized by myocardial dysfunction, heart failure leads to impaired pump performance (reduced cardiac output) or to frank heart failure and abnormal circulatory congestion. Congestion of systemic venous circulation may result... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed pressure — a difference of less than 30 mm Hg — occurs... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Clinicalsyndrome resulting from inability of myocardium to meet metabolicdemands of body. Combination of tachypnea, tachycardia,cardiomegaly, and hepatomegaly is cardiac failure until proved otherwise. In many cases, several... Principal Causes of Cardiac Failure ... Clinical Features and Diagnosis ... Diagnostic Approach ... Table 7.1. Diagnostic Classification of Common Causes of CardiacFailure ... References
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... Typically dramatic and terrifying to the patient, this sign refers to an attack of dyspnea that abruptly awakens the patient. Common findings include diaphoresis, coughing, wheezing, and chest discomfort. The attack abates after the patient sits up or stands for... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed pressure—a difference of less than... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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If an x-ray film demonstrates cardiomegaly, the physician must find out
what is causing this condition (Table 13). You have already
listened to the patient and he or she does not have a murmur. This seems to
exclude the common groups of causes—... Pictures
... READ EXCERPTS »
... Author:
Russell Cross, MD
What to Do - Interpret the Data
Wheezes are coarse whistling sounds generated by vibration of a narrowed airway from turbulent airflow. Wheezing often is equated with
asthma, reactive airways disease,... Suggested Readings
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