4. A second 45 year old male patient has also arrived at the ER complaining of f
ID: 88771 • Letter: 4
Question
4. A second 45 year old male patient has also arrived at the ER complaining of fatigue. Frankly, he smells like he has already had a few beers today. Amazingly, you can see a rhythmic distention of the jugular veins in time with his heart beat so it is easy to count! He also has pitting edema of his lower extremities. He too has sinus tachycardia of 130 bpm, 170/90 bp and a murmur too. But his x-rays shows right ventricular hypertrophy and hepatomegaly. His echocardiogram demonstrates tricuspid insufficiency and venous regurgitation. The doc-tor says this patient has heart failure too! When does the tricuspid valve close? ________________________ What is hepatomegaly? ____________________ Unfortunately, he vomits some blood and the doctor says we need to be concerned about esophageal varices, what are they? You note the patient’s sclera is yellow, what is the jaundice likely from? ____________ Why are his signs of heart failure so different from the first patient’s signs? (Think about which side of the heart is affected, left side or right side for each patient….)
Explanation / Answer
Tricuspid valve closes when the ventricles contract. The closure of tricuspid valve prevents blood flow back into the right atrium. At the same time, pulmonary valve opens and blood flows through pulmonary artery to lungs.
Hepatomegaly is abnormal enlargement of liver. Hepatomegaly can be the result of right heart failure and obstruction of blood flow from the liver.
Oesophageal varices are abnormal dilated veins in the lower part of oesophagus just above the junction of stomach. It occurs due to increased portal pressure and hepatic diseases. They have increased tendency to bleeding.
The jaundice is likely due to increased levels of bilirubin which is seen in liver disorders.
The patient is having right sided heart failure. So, he has the symptoms and signs of jaundice, oesophageal varices, hepatomegaly and pitting edema.
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