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Old 07-04-2011
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Stethoscope Surgical scar and a bruit

An 18-yr-old came to your office for a BP of 140/50. He has a well healed scar on medial aspect of left thigh 12 cm long. It occurred due to falling on a large sharp object. On auscultation of scar you hear bruit and palpable thrill.
Which is the diagnosis?
a. premature atheroscerosis
b. av fistula
c. scar tissue compressing femoral artery
d. congenital femoral artery bruit
e. PDA
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Old 07-04-2011
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B. AV fistula
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Old 07-04-2011
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Quote:
Originally Posted by confident View Post
a 18 y old came to your office for a bp of 140/50.he has a well healed scar on medial aspect of left thigh 12 cm long.it occured due to falling on a large sharp object.on auscultation of scar u hear bruit and palpable thrill.which is the diagnosis?
a.premature atheroscerosis
b.av fistula
c.scr tissue compressing femoral artery
d.congenital femoral artery bruit
e.pda
It is AV fistula, you can recognize it because you have a low diastolic pressure, because the peripheral vascular resistance is decreased due to the fistula that connects the arterial (high pressure) and venous (low pressure) system. The systolic pressure is increased because you have an increased CO, lets check some STEP 1 principles:

Blood pressure = Cardiac output x Peripheral vascular resistance (PVR)

In a AV fistula the PVR is decreased, and the CO is increased to compensate and mantain the blood pressure.
The diastolic pressure is the pressure in the system during diastole so it is related to PVR therefore it is low at this time.
The systolic pressure is high because the heart is pumping hard and a lot of blood at this time
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Old 07-04-2011
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Quote:
Originally Posted by confident View Post
a 18 y old came to your office for a bp of 140/50.he has a well healed scar on medial aspect of left thigh 12 cm long.it occured due to falling on a large sharp object.on auscultation of scar u hear bruit and palpable thrill.which is the diagnosis?
a.premature atheroscerosis
b.av fistula
c.scr tissue compressing femoral artery
d.congenital femoral artery bruit
e.pda
yes answer is av fistula..continuous murmur and palpable thrill, wide pulse pressure is indication of large portion of cardiac output is bypassing the systemic vascular resistance through fistula
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  #5  
Old 07-04-2011
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Originally Posted by Sadalssud View Post
It is AV fistula, you can recognize it because you have a low diastolic pressure, because the peripheral vascular resistance is decreased due to the fistula that connects the arterial (high pressure) and venous (low pressure) system. The systolic pressure is increased because you have an increased CO, lets check some STEP 1 principles:

Blood pressure = Cardiac output x Peripheral vascular resistance (PVR)

In a AV fistula the PVR is decreased, and the CO is increased to compensate and mantain the blood pressure.
The diastolic pressure is the pressure in the system during diastole so it is related to PVR therefore it is low at this time.
The systolic pressure is high because the heart is pumping hard and a lot of blood at this time
thanks...very well explained
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