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Cardiomegaly With Chronic Renal Failure

Cardiomegaly With Chronic Renal Failure Abstract A 57-year-old man was admitted to the hospital for evaluation of dyspnea, orthopnea, cough, and paroxysmal nocturnal dyspnea of four days' duration. Chronic renal failure secondary to Balkan nephropathy had necessitated long-term hemodialysis during the last two years. On admission, the BP was 141/94 mm Hg, with a paradoxical pulse of 20 mm Hg and a pulse of 95 beats per minute. With the patient's head elevated 30° above horizontal, jugular venous distention was noted to the angle of the jaw. The carotid arterial pulse was diminished in amplitude. Lung examination disclosed diffuse scattered inspiratory and expiratory wheezing with left subscapular dullness to percussion (Ewart's sign). There was a diffuse area of precordial dullness; the apical impulse was not palpable. S1 and S2 were diminished in intensity and no other heart sounds were noted. An ECG disclosed diminished QRS voltage, electrical alternans, and nonspecific repolarization changes, and a References 1. Feigenbaum H, Waldhausen JA, Hyde LP: The ultrasound diagnosis of pericardial effusion. JAMA 1965;191:711.Crossref 2. D'Cruz IA, Cohen HC, Prabhu R, et al: Diagnosis of cardiac tamponade by echocardiography. Circulation 1975;52:460-465.Crossref 3. Settle HP, Adolph RJ, Fowler NO, et al: Echocardiographic study of cardiac tamponade. Circulation 1977;56:951-959.Crossref 4. Martins JB, Kerber RE: Can cardiac tamponade be diagnosed by echocardiography? Experimental studies. Circulation 1979;60:737-742.Crossref 5. Schiller NB, Botvinick EH: Right ventricular compression as a sign of cardiac tamponade. Circulation 1977;56:774-779.Crossref 6. Vignola PA, Pohost GM, Caufman GD, et al: Correlation of echocardiogram and clinical findings in patients with pericardial effusion. Am J Cardiol 1976;37:701-707.Crossref 7. Schilt BF, Feigenbaum H, Weyman AE, et al: A new echocardiographic sign for cardiac tamponade , Circulation 1980;62( (suppl 3) ):100. 8. Armstrong WF, Helper DJ, Schilt BF, et al: Diastolic collapse of right ventricle: Echocardiographic evidence of occult cardiac tamponade. Am J Cardiol 1982;49:1010.Crossref 9. Gillam LD, Guyer D, King ME, et al: Hemodynamic compression of right atrial free wall: A new highly sensitive echocardiographic sign of cardiac tamponade. Am J Cardiol 1982;49:1010.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cardiomegaly With Chronic Renal Failure

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.00350130117021
Publisher site
See Article on Publisher Site

Abstract

Abstract A 57-year-old man was admitted to the hospital for evaluation of dyspnea, orthopnea, cough, and paroxysmal nocturnal dyspnea of four days' duration. Chronic renal failure secondary to Balkan nephropathy had necessitated long-term hemodialysis during the last two years. On admission, the BP was 141/94 mm Hg, with a paradoxical pulse of 20 mm Hg and a pulse of 95 beats per minute. With the patient's head elevated 30° above horizontal, jugular venous distention was noted to the angle of the jaw. The carotid arterial pulse was diminished in amplitude. Lung examination disclosed diffuse scattered inspiratory and expiratory wheezing with left subscapular dullness to percussion (Ewart's sign). There was a diffuse area of precordial dullness; the apical impulse was not palpable. S1 and S2 were diminished in intensity and no other heart sounds were noted. An ECG disclosed diminished QRS voltage, electrical alternans, and nonspecific repolarization changes, and a References 1. Feigenbaum H, Waldhausen JA, Hyde LP: The ultrasound diagnosis of pericardial effusion. JAMA 1965;191:711.Crossref 2. D'Cruz IA, Cohen HC, Prabhu R, et al: Diagnosis of cardiac tamponade by echocardiography. Circulation 1975;52:460-465.Crossref 3. Settle HP, Adolph RJ, Fowler NO, et al: Echocardiographic study of cardiac tamponade. Circulation 1977;56:951-959.Crossref 4. Martins JB, Kerber RE: Can cardiac tamponade be diagnosed by echocardiography? Experimental studies. Circulation 1979;60:737-742.Crossref 5. Schiller NB, Botvinick EH: Right ventricular compression as a sign of cardiac tamponade. Circulation 1977;56:774-779.Crossref 6. Vignola PA, Pohost GM, Caufman GD, et al: Correlation of echocardiogram and clinical findings in patients with pericardial effusion. Am J Cardiol 1976;37:701-707.Crossref 7. Schilt BF, Feigenbaum H, Weyman AE, et al: A new echocardiographic sign for cardiac tamponade , Circulation 1980;62( (suppl 3) ):100. 8. Armstrong WF, Helper DJ, Schilt BF, et al: Diastolic collapse of right ventricle: Echocardiographic evidence of occult cardiac tamponade. Am J Cardiol 1982;49:1010.Crossref 9. Gillam LD, Guyer D, King ME, et al: Hemodynamic compression of right atrial free wall: A new highly sensitive echocardiographic sign of cardiac tamponade. Am J Cardiol 1982;49:1010.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1984

References