Sun28November0333PM 18

Wheezing on chest auscultation secondary to left ventricular failure may be associated with which of the following:

True / False

Pulsus paradoxus Correct

Pleural effusion Correct

A fourth heart sound Incorrect answer selected

A third heart sound Correct

Pulsus alternans Incorrect answer selected

Explanation

The precise aetiology of wheezing may be difficult to diagnose. Left ventricular failure is characterized by symptoms of dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea. Inspiratory crackles characteristic of pulmonary oedema may be absent in the presence of pulmonary vasoconstriction.

Pulsus alternans is an arterial pulse that is alternately weak and strong, occurring with uniform QRS complexes. It is an uncommon sign but strongly indicates the presence of left ventricular disease. Third and fourth heart sounds may be present in left or right ventricular failure. Pleural effusions occur with severe cardiac failure.

Pulsus paradoxus in a patient with wheeze is suggestive of asthma but it can occur in cardiac diseases such as constrictive pericarditis and cardiac tamponade. However, these patients may develop biventricular failure rather than only left ventricular failure. Cardiac tamponade is also a cause of pulseless electrical activity leading to cardiac arrest.

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Average score: 70.58%

Times answered: 291