Cardiac examination

Her body mass index (BMI) was 31.5 kg/m2, which is more than 97% of that for her age. Her thyroid was not enlarged, the cardiac examination was normal, and the lung examination was normal without any wheezing (a high-pitched, flutelike noise with expiration often seen with asthma). She had a dark, thick skin rash in the folds on her neck called acanthosis nigricans. 

Thorough cardiac examination should look for possible cardiac source of embolism, including atrial fibrillation, mitral stenosis and prosthetic heart valves. Left ventricular hypertrophy suggests hypertension or aortic stenosis, and a displaced apex from a dilated left ventricle indicates underlying cardiac or valvular pathology. 

Come PC, Lee RT, Braunwald E. Noninvasive methods of cardiac examination. In Isselbacher KJ, Braunwald E, Wilson ID, et al, eds. Harrison s Principles of Internal Medicine, 13th ed. New York, McGraw-Hill, 1994 966-972. 

Fig. 1.20. Since the introduction of multislice detectors, it is a known issue that at the start and the end of each spiral scan, a region is irradiated for which no images can be reconstructed (red). That portion depends on the width of the detector and becomes more severe the wider the detector becomes and the shorter the scan region is. That problem can be overcome, but introducing a tube side collimator that continuously opens at the start of the scan and closes at the end of the scan. The Siemens SOMATOM Definition AS-i- is the first scanner offering that technology, which saves 10-25 % dose depending on the application. Typical dose savings using this technology are 10% for abdominal, 15% for thorax, 20% for head and 25% for cardiac examinations...

The two X-ray tubes of the scaruier can be operated at identical tube potentials to provide an increase in temporal resolution for cardiac examinations (Johnson et al. 2006) or photon flux in obese patients (Johnson et al. 2007). Alternatively they can be operated at two different tube energies potentially allowing differentiation various tissues based on different photon absorption rates at high and low kVp settings (Johnson et al. 2007). 

Cardiac arrhythmias are an important cause of morbidity and mortality approximately 400,000 people per year die from myocardial infarctions (MI) in the United States alone. Individuals with MI exhibit some form of dysrhythmia within 48 h. Post-mortem examinations of MI victims indicate that many die in spite of the fact that the mass of ventricular muscle deprived of its blood supply is often quite small. These data suggest that the cause of death is ventricular fibrillation and that the immediate availability of a safe and efficacious antiarrhythmic agent could have prolonged a number of Hves. The goals of antiarrhythmic therapy are to reduce the incidence of sudden death and to alleviate the symptoms of arrhythmias, such as palpitations and syncope. Several excellent reviews of the mechanisms of arrhythmias and the pharmacology of antiarrhythmic agents have been pubflshed (1,2). 

A preliminary report on rauwolscine by Chakravarti indicates that it is a cardiovascular depressant, shows hypotensive action and a relatively high toxicity. Koepfli s rauwolfine produces a fall in blood pressure, and stimulation of respiration in frogs it has a curare-like action. The rauwolfine of van Itallie and Steenhauer has been examined by Hartog and by de Boer, especially in regard to its cardiac action. According to Raymond-Hamet, it reverses the action of adrenaline. 

Microscopic examination of the heart revealed edematous separation of myofibrils that had resulted in compression thinning and fragmentation of myofibres. Myofibre outlines were less distinct, and there was loss of acidophilic staining. Mitotic figures were rare, indicating that growth of the cardiac tissue was suppressed. The incidence of cardiac lesions is given (Table VI). 

To certify the important role of Ca in the excitatory action of MTX, the effect of MTX on the Ca movements in cardiac muscle was examined at the cellular level. Figure 8 shows the time course of the Ca influx in the presence or absence of MTX (10 g/mL). The Ca uptake in the control experiment increased with time, to reach a saturation level about 5 min after administration of Ca. When MTX (10 g/mL) and Ca were applied simultaneously, the increase in Ca uptake at 5 min was 31% larger than that of the control. Furthermore, when the intracellular Ca concentration of isolated cardiac myocytes was determined from the Quin 2 fluorescence, MTX (10 g/mL) caused a marked increase in the free Ca concentration from 122 9 nM (control) to 380 23 nM, as shown in Figure 9. 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

The history and physical examination should be obtained while initial therapy is being provided. A history of previous asthma exacerbations (e.g., hospitalizations, intubations) and complicating illnesses (e.g., cardiac disease, diabetes) should be obtained. The patient should be examined to assess hydration status use of accessory muscles of respiration and the presence of cyanosis, pneumonia, pneumothorax, pneumomediastinum, and upper airway obstruction. A complete blood count may be appropriate for patients with fever or purulent sputum. 

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