Thirty year old with ankle edema – Medicine MCQ – CVS – Answer
Thirty year old individual presents with ankle edema. He gives history of aspiration of fluid from the epigastric region two years back and medications for 6 months. Which of the following physical finding can link the two together? – Correct answer: d) Kussmaul’s sign
History is suggestive of aspiration of pericardial effusion which is usually done from the epigastric route. It is usually done under fluoroscopic guidance in the cardiac catheterization laboratory. In an emergency it can be done in the intensive care unit or emergency department with bedside echocardiographic guidance. A person with history of tuberculous pericardial effusion can sometimes present later with features of constrictive pericarditis. Ankle edema in this case is due to severe right sided congestion as venous drainage into the heart is impeded by the thickened pericardium. Venous pressures are very much elevated, causing edema, hepatomegaly and ascites. It can even be mistaken for cirrhosis liver unless one is careful in evaluating the jugular venous pressure.
Kussmaul’s sign is a paradoxical inspiratory rise in jugular venous pressure, seen in constrictive pericarditis. But the commonest cause of Kussmaul’s sign in an intensive care unit is likely to be right ventricular infarction. Other causes of severe right ventricular failure can also manifest a Kussmaul’s sign.
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