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Old 08-18-2011
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Default sarcoidosis

A patient with sarcoidosis presents with worsening dyspnea and orthopnea. Her vital signs are: HR 85, blood pressure 138/79, RR 20, oxygen saturation 97% on room air. She is followed by a cardiologist, who suggests repeat heart pressure measurements via cardiac catheterizations. Given this patientís disease and worsening symptoms, what changes should you expect in the heart pressure measurements?
A. Increased right ventricular pressures
B. Increased right atrial pressures
C. Increased inferior vena cava pressures
D. Increased left ventricular pressures
E. Increased left atrial pressures
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Old 08-18-2011
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please be A ???:sorry:
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ha ha usmle 2011 i made d same mistake think again
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Quote:
Originally Posted by ricko335 View Post
A patient with sarcoidosis presents with worsening dyspnea and orthopnea. Her vital signs are: HR 85, blood pressure 138/79, RR 20, oxygen saturation 97% on room air. She is followed by a cardiologist, who suggests repeat heart pressure measurements via cardiac catheterizations. Given this patientís disease and worsening symptoms, what changes should you expect in the heart pressure measurements?
A. Increased right ventricular pressures
B. Increased right atrial pressures
C. Increased inferior vena cava pressures
D. Increased left ventricular pressures
E. Increased left atrial pressures
its B dude right atrial pressure increases so much that it becomes greater than left one in sarcoidosis patient ...
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ha ha usmle 2011 i made d same mistake think again

great..... I was thinking Pulmonary Hypertension.... Now... I don't know.
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i have no idea about this...
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A. Increased right ventricular pressures
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Old 08-18-2011
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Answer should be C, because the heart is RESTRICTIVE, which means not much blood is going to the ventricles, the diastolic pressure is compromise and the systolic initially is normal.

Later the heart stop getting enough blood during diastolic which leads to decrease a Ventricular filling and SV. So they blood is backing up to the Systemic system which develop increase to the Venas cava and pulmonary circulation.
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Also the atrial can be increase, but initially but eventually i think the systemic circulation will be the dominant increases here...
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Answer should be C, because the heart is RESTRICTIVE, which means not much blood is going to the ventricles, the diastolic pressure is compromise and the systolic initially is normal.

Later the heart stop getting enough blood during diastolic which leads to decrease a Ventricular filling and SV. So they blood is backing up to the Systemic system which develop increase to the Venas cava and pulmonary circulation.
yup restriction is also the reason but restriction is equal in every chamber of heart so i think the main culprit is vitamin d activated macrophaes in sarcoidosis patients increases calcium levels and increases TPR so right atrial pressure increases alottttt ... i have read it somewherre and dont know exactly about inferior vena cava pressure ..
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Default i am really confused

i am so confused that i am going to choose increased left atrial pressures as my answer.
i dont really have any reason for this except that theres orthopnea as a symptom and that reflects problem with the left side of the heart.

i intially went for A but you said it was wrong,

please kindly post the right answer with the explanation. i am having challenges with all this "pressure business" in the heart and lungs

thanks

Quote:
Originally Posted by ricko335 View Post
A patient with sarcoidosis presents with worsening dyspnea and orthopnea. Her vital signs are: HR 85, blood pressure 138/79, RR 20, oxygen saturation 97% on room air. She is followed by a cardiologist, who suggests repeat heart pressure measurements via cardiac catheterizations. Given this patientís disease and worsening symptoms, what changes should you expect in the heart pressure measurements?
A. Increased right ventricular pressures
B. Increased right atrial pressures
C. Increased inferior vena cava pressures
D. Increased left ventricular pressures
E. Increased left atrial pressures
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The correct answer is E.
Any disease process that can infiltrate the myocardium can result in a restrictive cardiomyopathy. These include: amyloidosis, sarcoidosis, hemochromatosis, and fibroelastosis. The patient above has developed worsening dyspnea and orthopnea, suggestive of diastolic left ventricular dysfunction. The heart is restricted and cannot properly fill despite adequate preload. This results in blood backing up into the lungs with subsequent pulmonary edema, and both orthopnea and dyspnea. Because this is mainly diastolic dysfunction, the pressures would be elevated in the left atrium since filling into the left ventricle is compromised (left ventricle systolic function and left ventricle pressures are still normal). Eventually, diastolic dysfunction will cause severe pulmonary hypertension and compromise the right side of the heart. However, since the patient is still 97% on room air, pulmonary hypertension has not developed yet.
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look at d vitals that is where even i made d mistake
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