General Surgery Rotation

General Surgery: Dyspnea on exertion

Arrhythmia: Atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardia

  • Hx: Palpitations, syncope
  • PE: Irregular rhythm, pauses
  • DX: ECG, event recorder, Holter monitor, stress testing

Myocardial: Cardiomyopathies, coronary ischemia

  • Hx: Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, chest pain or tightness, prior coronary artery disease or atrial fibrillation
  • PE: Edema, JVD, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S4
  • Dx: ECG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography

Restrictive: Constrictive pericarditis, pericardial effusion/tamponade

  • Hx: chest pain, dyspnea
  • PE: Paradoxical pulse (exaggerated variation in blood pressure with respiration).
  • Dx: EKG showing low voltage QRS along with electric alternans (see media section). Echocardiogram with increased pericardial fluid. Radiograph: Water bottle heart

Valvular: Aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis

  • Hx: Dyspnea on exertion
  • PE: Murmur, JVD
  • Dx: Echocardiography
General Surgery: Aortic aneurysm/dissection (Prev Lesson)
(Next Lesson) General Surgery: Claudication
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