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Findings of Cor pulmonale

Characteristic findings of Cor pulmonale


Common etiologies :

  • COPD
  • Interstitial lung disease
  • Pulmonary vascular disease (eg, thromboembolic)
  • Obstructive sleep apnea


Symptoms :

  • Dyspnea on exertion, fatigue, lethargy
  • Exertional syncope (due to decreased CO)
  • Exertional angina (due to increased myocardial demand)


Examination : 

  1. Peripheral edema
  2. Increased Jugular venous pressure with prominent a wave
  3. Loud S2
  4. Right sided heave
  5. Pulsatile liver from congestion
  6. Tricuspid regurgitation murmur


Imaging :

  • EKG : partial or complete RBBB , right axis deviation, right ventricular hypertrophy right ventricular enlargement

  • Echocardiogram : Pulmonary hypertension, dilated right ventricle, tricuspid regurgitation


Right heart catheterization: Gold standard for Dx showing right ventricular dysfunction, pulmonary HTN and no left heart disease.

Difference between Hydrocele and Varicocele

Hydrocele:--Painless enlargement of the Scrotum.
Can be Unilateral or Bilateral.

Diagnosis with Transillumination. However transillumination cannot confirm the diagnosis because it also may indicate hernia.

Ultrasound can be done to confirm the diagnosis.

Varicocele:-Varicocele is a mass of enlarged veins that develops in the spermatic cord.

A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left
testicle. The left spermatic vein drains into the renal vein .

Highest in men between the ages of 15 and 25.
The sudden appearance of varicocele in an older man
may indicate a renal tumor blocking the spermatic
vein.

S&S:--Asymptomatic or may have:--

  • Ache in the testicle
  • Feeling of heaviness
  • Infertility
  • Atrophy of the testicle
  • Visible or palpable enlarged vein 


Diagnosis:--Large varicoceles may be seen with the naked eye. Medium-sized varicoceles may be detected during physical examination by palpating--"Bag of Worms

Doppler ultrasonography uses ultrasound echos to detect the characteristic sound of the backflow of
blood through the valve.

Treatment:--Surgical Ligation of the affected Spermatic veins.

Summary :

varicocele is described as a "bag of worms", will not transilluminate
hydrocele is collection of fluid in tunica vaginalis, will feel different depending whether it is communicating or not, will transilluminate

Types of Miscarriage

Threatened 

  • Vaginal bleeding
  • Closed cervical os
  • Fetal cardiac activity


Missed
  • No vaginal bleeding
  • Closed cervical os
  • No fetal cardiac activity or empty sac


Inevitable

  • Vaginal bleeding
  • Dilated cervical os
  • Products of conception may be seen or felt at or above cervical os


Incomplete 

  • Vaginal bleeding
  • Dilated cervical os 
  • Some products of conception expelled and some remain


Complete

  • Vaginal bleeding or none
  • Closed cervical os 
  • Products of conception completely expelled

PDA (patent ductus arteriosus) dependent Congenital Heart Diseases

  • COA (coarctation of aorta)

  • D-TGA (d-transposition of the great arteries)


  • Hypoplastic left heart syndrome


  • TAPVR (total anomalous pulmonary venous return)


  • Tricuspid atresia

Heart murmur maneuvers (Easy way to Understand)