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Old 05-05-2013
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Question constrictive pericarditis vs cardiac tamponade JVP findings

guys...please could you explain me.....why there is differences in y descent in pericardial tamponade and constrictive pericarditis..?

absent y descent in cardiac tamponade....(due to elevated rt.atrial pressure that masks it..?)

prominent y descent in constrictive pericarditis(square root sign..?)


thanks...
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Old 05-05-2013
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guys pls anyone...????
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Old 05-06-2013
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Quote:
Originally Posted by venky2600 View Post
guys...please could you explain me.....why there is differences in y descent in pericardial tamponade and constrictive pericarditis..?

absent y descent in cardiac tamponade....(due to elevated rt.atrial pressure that masks it..?)

prominent y descent in constrictive pericarditis(square root sign..?)


thanks...
Not sure on this one, but to add to what you've wrote in brackets. I recall there's flat neck veins in cardiac tamponade (its one of the ways to differentiate it from tension pneumothorax isnt it?) so it wouldnt make sense for Rt atrial pressure to be elevated?

I could be completely wrong about this.

On a side note, I have not seen JVP abnormalities being tested heavily. I always struggled with this and the only notes I made & try to remember are the following:

1. Marked 'y' descent = constrictive pericarditis
2. Canon 'A' wave = HOCM
3. Large 'v' wave = Mitral Regurgitration
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Quote:
Originally Posted by drsaid View Post
Not sure on this one, but to add to what you've wrote in brackets. I recall there's flat neck veins in cardiac tamponade (its one of the ways to differentiate it from tension pneumothorax isnt it?) so it wouldnt make sense for Rt atrial pressure to be elevated?

I could be completely wrong about this.

On a side note, I have not seen JVP abnormalities being tested heavily. I always struggled with this and the only notes I made & try to remember are the following:

1. Marked 'y' descent = constrictive pericarditis
2. Canon 'A' wave = HOCM
3. Large 'v' wave = Mitral Regurgitration


really thankful...as i thought no one would reply.....

No, there will be distended neck veins(not flat ) in cardiac tamponade as well which makes beck triad-----the differentiating feature between tension pneumothorax and it is absence of SOB/dyspnea in tamponade and presence in pneumothorax

they gave all the JVP findings in mtb's but they arent clear....
i mean the difference between constrictive pericarditis and tamponade is------> in diastole there is problem of filling totally (in tamponade) and at the end when pressure rises(in constrictive pericarditis ----which makes charectaristic pericardial knock)
it has some thing with this change in diastolic pressures which changes JVP(but i dont know clearly)
in Step up medicine ---they just gave these JVP findings...

thanks--i really dont know abt. MR JVP finding..
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Old 05-06-2013
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and regarding canon A wave----until now i only knew it is the finding in 3rd degree AV block-----i dont know abt HOCM---where did you find it? can you share the info please..?

thanks
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thanks for correcting me. i was confusing it with hypovolemia which has flat neck veins and low cvp.
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Quote:
Originally Posted by venky2600 View Post
and regarding canon A wave----until now i only knew it is the finding in 3rd degree AV block-----i dont know abt HOCM---where did you find it? can you share the info please..?

thanks
Kaplan IM Cardiology Pg. 141

Clinical Manifestation of HOCM:
-Dyspnea, angina, presyncope, syncope and palpitations.
-Large A jugular A wave, bifid carotid pulse, palpable S4 gallop, systolic murmur & thrill, Mitral regurg
-Sudden death can sometimes be the first manifestation
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Old 05-07-2013
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http://www.library.ohiou.edu/hsm/TEXT/TAMP_CPC_txt.html

i finally found the related link for it

it's as i told before----in tamponade--> there is compromised diastolic filling --->which lead to absent y descent (y wave is due to passive filling of ventricles after opening of tricuspid valve)
whereas in constrictive pericarditis--> there is compromised diastolic flow,but only at end of diastole(not total as in tamponade)--->so prominent y descent is seen with peak wave until plateau occurs due to pericardial knock and gradually descents(which makes square root sign)

thanks..

Last edited by venky2600; 05-07-2013 at 02:20 AM.
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Thanks for explaining it.
Also, I read today that Canon A-waves are also found in Ventricular Tachycardias (VT) caused by simultaneous contraction of atrium and ventricles.

So that makes 3 differentials for canon-A waves.
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