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Demonstration of the parasternal heave using a long Q-tip, known as the "Cooney technique" ( @

perfectly with the X descent ... #PhysicalExam #Clinical ... PrecordialImpulse #Cardiology

Constrictive Pericarditis on Echocardiogram

Patient was referred to cardiology for evaluation of dyspnea. JVP was enough to

was referred to cardiology ... CP, prominent y descent ... Echocardiogram #POCUS #clinical ... #cardiology #a4c

Kussmaul's sign in Constrictive Pericarditis

A 50-year-old woman with a remote history of mediastinal lymphoma (age

The rapid Y descent ... PhysicalExam #Video #Clinical ... Pericarditis #Cardiology

Kussmaul's Sign and Friedreich's Sign on Neck Examination

A middle-aged M with unknown PMH presents with dyspnea.

(sharp/deep Y-descent ... #PhysicalExam #Clinical ... #Video #Cardiology

Restrictive Cardiomyopathy - Diagnosis and Causes
Clinical: Dyspnea, Exercise Intolerance, ↑ "Right Sided-Symptoms" (ascites, hepatomegaly, ↑↑peripheral edema)
Physical

Diagnosis and Causes Clinical ... Prominent X and Y Descents ... #differential #cardiology

Giant A waves caused by pulmonary HTN. There are two clearly discernible descents (X and Y)

clearly discernible descents ... #PhysicalExam #Clinical ... #Video #Cardiology

Jugular Waveform Components
• a wave - due to atrial contraction: It occurs just before

• x descent - ... • x descent - ... • y descent - ... Thus the y descent ... #PhysicalExam #cardiology

Abnormal Jugular Venous Pressure Waveforms - Differential Diagnosis
- Absent a wave - Atrial fibrillation, sinus

- Prominent x descent ... percarditis - Slow y descent ... myxoma - Rapid y descent ... defect - Absent y descent ... #PhysicalExam #cardiology

Abnormal Jugular Venous Pressure (JVP) Algorithm
Outward Wave / Peak
• With Every Beat

Concordant with S1 - X-Descent ... Discordant with S1 - Y-Descent ... Algorithm #diagnosis #cardiology

Acute Mountain Sickness
Low partial pressure of oxygen at high altitude
• Stop ascent
• Supportive

altitude • Stop ascent ... hyperbaric chamber • Descent

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