By Glenn N. Levine
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Additional info for Cardiology Secrets, Third Edition
Com 3. html 4. com/medstud/ecg/ 5. Dublin D: Rapid interpretation of EKGs, Tampa, Fla, 2000, Cover Publishing. 6. Levine GN: Diagnosing (and treating) arrhythmias made easy, St. Louis, 1998, Quality Medical Publishers. 7. Levine GN, Podrid PJ: The ECG workbook, Armonk, NY, 1995, Futura Publishing. 8. Mason JW, Hancock EW, Gettes LS: Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list, a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology, J Am Coll Cardiol 49(10):1128-1135, 2007.
A hyperdynamic impulse (often referred to as a ‘‘thrust’’) that is forceful enough to lift the examiner’s finger can be encountered in situations of volume overload and increased output (such as aortic regurgitation and ventricular septal defect) but may also be felt in normal subjects with very thin chests. Similarly, a hypodynamic impulse can be due to simple obesity but also to congestive cardiomyopathy. In addition to being hypodynamic, the precordial impulse of these patients is large, somewhat sustained, and displaced downward/laterally.
Tr Tr SVC Aorta Aor RPA PT RA LAA RV IVC RPA LPA LPA RV LV LV IVC A Posteroanterior B Lateral Figure 4-1. Diagrammatic representations of the anatomy of the chest radiograph. Aor, Aorta; IVC, inferior vena cava; LAA, left atrial appendage; LPA, left pulmonary artery; LV, left ventricle; PT, pulmonary trunk; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; SVC, superior vena cava; Tr, trachea; IVC, inferior vena cava; LPA, left pulmonary artery; LV, left ventricle; RPA, right pulmonary artery; RV, right ventricle; Tr, trachea.
Cardiology Secrets, Third Edition by Glenn N. Levine