Cardiology Secrets, Third Edition by Glenn N. Levine

By Glenn N. Levine

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Torsades de pointes, in which the QRS axis seems to rotate about the isoelectric point. (From Olgin JE, Zipes DP: Specific arrhythmias: diagnosis and treatment. ) 15. What are cerebral T waves? Cerebral T waves are strikingly deep and inverted T waves, most prominently seen in the precordial leads, that occur with central nervous system diseases, most notably subarachnoid and intracerebral hemorrhages. They are believed to be due to prolonged and abnormal repolarization of the left ventricle, presumably as a result of autonomic imbalance.

The CXR is not sensitive for the detection of a pericardial effusion, and it may not be helpful in determining the extent of an effusion. Smaller pericardial effusions are difficult to detect on a CXR but can still cause tamponade physiology if fluid accumulation is rapid. A large hourglass cardiac silhouette (Fig. 4-5), however, may suggest a large pericardial effusion. Distinguishing pericardial fluid from chamber enlargement is often difficult. Figure 4-5. The water bottle configuration that can be seen with a large pericardial effusion.

100. Patients with cocaine-induced chest pain should be treated with intravenous benzodiazepines, which can have beneficial hemodynamic effects and relieve chest pain, and aspirin therapy, as well as nitrate therapy if the patient remains hypertensive. Beta-blockers (including labetolol) should not be administered in the acute setting of cocaine-induced chest pain. CARDIOVASCULAR PHYSICAL EXAMINATION Salvatore Mangione, MD CHAPTER 1 I. GENERAL EXAMINATION Editor’s Note to Readers: For an excellent and more detailed discussion of the cardiovascular physical examination, read Physical Diagnosis Secrets, ed 2, by Salvatore Mangione.

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