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ENARM
FISIOLOGIA
EKG
EKG
• E STAN DAR I ZAC I Ó N
Velocidad del Electrocardiógrafo: 25 mm/ Segundo.
EKG
EKG
INTERVALOS
PR:
Se denomina así, al espacio que va del inicio de la Onda P al comienzo de la Onda R.
Valor normal: 120 a 200 milisegundos ( 0.12 – 0.20 segundos).
COMPLEJO QRS:
Corresponde a la activación del miocardio ventricular.
Valor Normal: 60 a 100 milisegundos ( 0.06 – 0.10 segundos).
QT:
Se mide desde el inicio del Complejo QRS hasta el final de la Onda T y corresponde a la duración total de la Sístole
Ventricular.
Valor normal: 240 a 480 milisegundos ( 0.24 – 0.48 segundos ).
( Varia de acuerdo a la frecuencia cardiaca )
SEGMENTO
ST:
Es el intervalo normalmente iso-electrico entre el final del Complejo QRS y el inicio de la Onda T.
Valor normal: 60 a 160 milisegundos ( 0.06 a 0.16 segundos )
EKG
• INTERVALO QT
P r o l o n g a d o:
C a r d i o p a t í a I s q u é m i c a.
I. C. C.
M i o c a r d i t i s.
Drogas: Quinidina, Amiodarona, Antidepresivos triciclicos...
H i p o m a g n e s e m i a.
H i p o c a l c e m i a.
H i p o k a l e m i a ?.
A c o r t a d o:
R e p o l a r i z a c i ó n p r e c o z.
D r o g a s: Digital...
H i p e r c a l c e m i a.
H i p e r k a l e m i a.
HIPOKALEMIA: POTASIO SÉRICO < 3.5 mEq / L
HIPOKALEMIA
ONDA P QRS
PLANA ENSANCHADO
TRATAMIENTO
• Leve (5 – 5.5) : manejo de causa,
evaluar FR
• Moderada (5.5 – 6) : no alteraciones
EKG supender ingresos
• Aumentar excreción : diuréticos
• Compromiso renal: Kayexalate: 1-2
g/K/dosis cada 4- 6horas VO, diluido en
sorbitol 4cc al 20% o dextrosa
Pediatric in Review, Vol 17, No 11, 1996
TRATAMIENTO
• AGONISTAS B- ADRENÉRGICOS: MNB o EV
Dosis: 0,01 mg/K/dosis / 30-60 ´
v
• La onda " " se debe al LLENE PASIVO DE LA AURÍCULA DERECHA debido al
retorno venoso normal, mientras la VÁLVULA TRICÚSPIDE PERMANECE CERRADA
durante el sístole. Por lo tanto, es una onda que ocurre al mismo tiempo del sístole
y que se vería sobre el vena yugular. El colapso que se observa después de la onda
y
"v", se denomina el descenso " ", que corresponde al PASO DE LA SANGRE
DE LA AURÍCULA AL VENTRÍCULO DURANTE EL DIÁSTOLE, después que se abre la
válvula tricúspide. VAY
• Con registros muy finos, se describe una pequeña muesca ubicada en el descenso
c
de la onda "a", que se ha llamado la onda " ", ATRIBUIDA AL CIERRE DE LA
VÁLVULA TRICÚSPIDE, después que se ha terminado de contraer la aurícula
derecha y está comenzando el sístole, pero no es posible de ver a simple vista.
PULSO VENOSO YUGULAR
• Para diferenciar si una determinada onda que se ve sobre la vena
yugular es antes o durante el sístole, conviene estar palpando al
mismo tiempo una arteria (ej: pulso radial). La onda "a" antecede
al pulso arterial y la "v" coincide con él. El descenso "x" sigue a la
onda "a" y el descenso "y" sigue a la onda "v".
• En condiciones patológicas estas ondas presentan alteraciones, que
pueden ser:
• onda "a" grande: cuadros de hipertensión pulmonar, estenosis de
la válvula pulmonar, estenosis de la válvula tricúspide (debido a la
resistencia que encuentra la aurícula derecha para vaciarse al
ventrículo).
• onda "v" muy grande: en insuficiencia tricúspide (debido al reflujo
de sangre durante el sístole).
• ausencia de onda "a": en fibrilación auricular (la aurícula no se
contrae al unísono).
FARMACOLOGIA
CASO CLINICO
A 72-year-old woman has new-onset atrial flutter with a
ventricular rate of 150/min. She is hemodynamically stable
with a blood pressure of 155/90 mm Hg, but is
experiencing palpitations. Which of the following drugs is
the best intravenous choice for controlling the heart rate?
• (A) diltiazem
• (B) lidocaine
• (C) aminophylline
• (D) magnesium
• (E) atropine
EXPLICACION
(A) Diltiazem and verapamil may be of help in both
acute paroxysms of atrial flutter and chronic
management. The other choices have no effect on
the AV node to slow down flutter, and atropine
accelerates AV conduction. At times, catheter
ablation of the flutter pathway is required in chronic
atrial flutter. Surgical ablation is reserved for cases
where other surgical interventions are required.
(Fuster, p. 844)
CASO CLINICO
A 63-year-old woman on digitalis for chronic atrial fibrillation experiences
fatigue, nausea, and anorexia. Her pulse is regular at 50 beats/min, and
the heart sounds, chest, and abdominal examinations are normal. On the
ECG, no P waves are visible and the QRS complexes are narrow and
regular. Which of the following is the most appropriate management step?
• (A) thiazides
• (B) spironolactone
• (C) clonidine
• (D) prazosin
• (E) beta-blockers
• (F) hydralazine
• (G) ACE inhibitors
• (H) calcium channel blockers
EXPLICACION
(G) ACE inhibitors have no adverse effects on
glucose or lipid metabolism and minimize the
development of diabetic nephropathy by
reducing renal vascular resistance and renal
perfusion pressure. The goal for blood pressure
control in diabetics is set at 130/80 mm Hg which
is lower than in nondiabetics. This lower pressure
is important in preventing progression of renal
disease and other end-organ damage. (Kasper, p.
1479)
CASO CLINICO
A 60-year-old woman with no past medical history has an elevated
blood pressure of 165/80 mm Hg on routine evaluation. Repeated
measurements over the next month confirm the elevated pressure.
Physical examination, routine blood count, and biochemistry are all
normal.
• (A) thiazides
• (B) spironolactone
• (C) clonidine
• (D) prazosin
• (E) beta-blockers
• (F) hydralazine
• (G) ACE inhibitors
• (H) calcium channel blockers
EXPLICACION
(A) Thiazides have been a cornerstone in most trials of
antihypertensive therapy. Their adverse metabolic
consequences include renal potassium loss leading to
hypokalemia, hyperuricemia from uric acid retention,
carbohydrate intolerance, and hyperlipidemia. The current
U.S. Joint National Committee (JNC-7) guidelines suggest
starting with thiazide diuretics because of their proven
efficacy in lowering mortality and morbidity in large clinical
trials. Other agents are considered if there are comorbidities
such as diabetes or CAD. (Kasper, pp. 1472, 1478)
CASO CLINICO
A 26-year-old woman develops new-onset hypertension. She has no
other medical problems and is not taking any medications. She
undergoes an evaluation for secondary hypertension and is found
to have unilateral renal artery stenosis.
• (A) thiazides
• (B) spironolactone
• (C) clonidine
• (D) prazosin
• (E) beta-blockers
• (F) hydralazine
• (G) ACE inhibitors
• (H) calcium channel blockers
EXPLICACION
(G) Although contraindicated in bilateral
stenosis, ACE inhibitors are the drug of choice
in unilateral renal artery stenosis. When ACE
inhibitors are used in patients with impaired
renal function, renalfunction should be
monitored twice a week for the first 3 weeks.
(Kasper, p. 1479)
CASO CLINICO
A 70-year-old man has isolated systolic hypertension. On
examination, his blood pressure is 170/80 mm Hg, heart and
lungs are normal. He has no other medical conditions.
• (A) thiazides
• (B) spironolactone
• (C) clonidine
• (D) prazosin
• (E) beta-blockers
• (F) hydralazine
• (G) ACE inhibitors
• (H) calcium channel blockers
EXPLICACION
(A) Thiazides seem to work particularly well in
Blacks and the elderly. Younger individuals and
Whites respond well to beta-blockers, ACE
inhibitors, and calcium channel antagonists.
Isolated systolic hypertension is a common
occurance in the elderly. It is due to
arteriosclerosis of the large arteries. Treatment of
isolated systolic hypertension with low-dose
thiazides results in lower stroke rates and death.
The goal for treatment is a blood pressure of
140/90 mm Hg. (Kasper, pp. 1471, 1480)
CASO CLINICO
A 57-year-old man has a blood pressure of 155/90 mm Hg on routine
evaluation. He had coronary artery bypass grafting 4 years earlier,
after which he has had no further chest pain. The rest of the
examination is normal, and the elevated blood pressure is
confirmed on two repeat visits.
• (A) thiazides
• (B) spironolactone
• (C) clonidine
• (D) prazosin
• (E) beta-blockers
• (F) hydralazine
• (G) ACE inhibitors
• (H) calcium channel blockers
EXPLICACION
(E) Beta-blockers are the most appropriate
choice for the treatment of hypertension in
patients with CAD. They lower mortality in
patients with CAD as well as hypertension.
ACE inhibitors can also be used, especially if
there is left ventricular dysfunction, or the
patient has multiple cardiovascular risk factors
such as diabetes or dyslipidemia. (Kasper, p.
1479)
PREGUNTAS
Fármacos utiles en ICC?
Captopril y metoprolol
Tratamiento de elección para la fibrilación atrial crónica?
Metoprolol
Fármaco útil en la hipertensión pulmonar primaria?
Nifedipino
Que fármaco puede disminuir la mortalidad por protección
miocardica directa contra las catecolaminas?
Metoprolol
En que patología esta contraindicado el uso de los IECAS?
Estenosis bilateral de la arteria renal
ANGINA DE PECHO
ANGINA DE PECHO
ANGINA ESTABLE
• Es la más frecuente, aparece con el esfuerzo y
remite espontáneamente con el reposo y/o la
medicación. Posee una duración de pocos
minutos y presenta un patrón regular, por lo que
el paciente puede ser capaz de identificarla e
incluso predecir su aparición. Su origen se halla
primordialmente en una arteriopatía
aterosclerótica que causa la progresiva reducción
de la luz vascular, de uno o varios vasos
coronarios, en porcentajes del orden del 70% o
superior.
ANGINA INESTABLE
• La angina inestable no se relaciona con un mayor trabajo cardíaco,
es decir no deriva de un mayor consumo miocárdico de oxígeno. Su
causa debe buscarse en una disminución aguda del flujo cardíaco
coronario, que puede deberse a la complicación de una placa
aterosclerótica coronaria por erosión, fisura o rotura y trombosis
sobreañadida que cause una interrupción súbita del flujo coronario
o por causas extrínsecas al árbol coronario que produzcan
inestabilización. Su sintomatología clínica es muy similar a la que
registra el infarto agudo de miocardio, sin embargo, en la angina
inestable no se produce necrosis miocárdica.
• (A) hyperkalemia
• (B) hypercalcemia
• (C) hypernatremia
• (D) pericarditis
• (E) ventricular aneurysm
EXPLICACION
(A) No atrial activity is detected. The ventricular
rate is slightly irregular. Beat number 4 is a
ventricular premature contraction. The T
waves are tall and markedly peaked. This type
of T wave is characteristic of hyperkalemia, as
is absence of visible atrial activity. The
potassium level was 8.2 mmol/L. (Fuster, p.
313)
SX WPW
SX BRUGADA
ANTIARRITMICOS
MUERTE SUBITA
DESFIBRILADOR
INSUFICIENCIA CARDIACA
INSUFICIENCIA CARDIACA
INSUFICIENCIA CARDIACA
INSUFICIENCIA CARDIACA
INSUFICIENCIA CARDIACA
TRANSPLANTE CARDIACO
ENDOCARDITIS INFECCIOSA
Lesión endotelial
por factores -hemodinámicos Maniobras que producen
-traumáticos traumatismo de piel y/o
mucosas:drogadicción
focoséptico
Presencia de
inmunocomplejos
Endocarditis infecciosa Bacteriemia
Fisiopatología transitoria
Depósito de
fibrina
Adherencia y
Endocarditis trombótica colonización
no bacteriana
VEGETACION
Destrucción SÉPTICA Bacteriemia persistente
valvular Inmunocomplejos
Embolia pulmonar
o sistémica vasculitis Esplenomegalia
Metastásis
glomerulonefritis
Aneurismas sépticas
MANIFESTACIONES micóticos
CARDÍACAS MANIFESTACIONES EXTRACARDÍACAS
Endocarditis infecciosa
Profilaxis antibiótica en procedimientos dentales,
cavidad oral, respiratorio y esófago
• Ampicilina 2 gr IM o IV + Gentamicina
1,5mg/Kg/ 30 minutos antes, 6 h después
Ampicilina 1gr IM/IV o Amoxicilina oral 1gr
Alérgicos a penicilina
• -A 42-year-old man develops shortness of breath (SOB) and chest pain 7 days after an open cholecystectomy.
His blood pressure is 145/86 mm Hg, pulse is 120/min, respirations 24/min, and oxygen saturation of 97%.
Pulmonary embolism is clinically suspected. Which of the following is the most common ECG finding of
pulmonary embolism?
• -A 25-year-old woman is found to have a midsystolic murmur on routine evaluation. The murmur does not
radiate but it does increase with standing. She otherwise feels well and the rest of the examination is normal.
• R = Mitral valve prolapsed.
• -A 65-year-old man with a previous history of an anterior MI comes for follow-up. On examination, he has a
systolic murmur heard best at the apex and radiating to the axilla. Transient external compression of both arms
with blood pressure cuffs 20 mm Hg over peak systolic pressure increases the murmur.
• R = Regurgitación mitral
• 4. Cual es el índice valvular aórtico?
• R = 3-4 cm3.
• A 63-year-old woman develops exertional angina and has had two episodes of syncope.
Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2.
Which of the following is the most likely diagnosis?
• -A 75-year-old man is bought to the hospital because of a syncopal episode. There was no incontinence or post-event confusion. On examination, his blood
pressure is 140/80 mm Hg, pulse 72/min with no postural changes. His second heart sound is diminished and there is a systolic ejection murmur that radiates
to the carotids. With the Valsalva maneuver, the murmur decreases in length and intensity.
• R = Aortic stenosis.
• -A 32-year-old asymptomatic woman has a rapidly rising, forceful pulse that collapses quickly. Which of the following is the most likely diagnosis?
• (A) mitral stenosis
• (B) mitral regurgitation
• (C) aortic stenosis
• (D) aortic regurgitation
• Respuesta correcta D
• 18. Como se trata una fibrilación ventricular que no responde a una cardioversión?
• R = Amiodarona y RCP
• -A 69-year-old woman complains of some atypical chest pain 2 days prior to presentation. On examination, the
JVP is at 8 cm, positive Kussmaul’s sign, and normal heart sounds. The lungs are clear. The ECG is abnormal, and
the CXR shows a normal cardiac silhouette.
• 20. Que tan frecuente se presenta un AUNERISMA VENTRICULAR IZQUIERDO POST IAM?
• R = 20% y se da el dx por medio de la ELEVACIÓN PERSISTENTE DEL ST DURANTE 4-8 SEMANAS.
• -Three months after an anterior MI, a 73-yearold man has a follow-up ECG. He is clinically feeling well with no
further angina symptoms. His ECG shows Q waves in the anterior leads with persistant ST-segment elevation.
The current ECG is most compatible with which of the following diagnosis?
• -A 67-year-old man presents with an anterior myocardial infarction (MI) and receives thrombolytic therapy.
Three days later, he develops chest pain that is exacerbated by lying down, and his physical findings are normal
except for a friction rub. His ECG shows evolving changes from the anterior infarction but new PR-segment
depression and 1-mm ST-segment elevation in all the limb leads. Which of the following is the most likely
diagnosis?
• (A) reinfarction
• (B) pulmonary embolus
• (C) viral infection
• (D) post-MI pericariditis
• (E) dissecting aneurysm
• Respuesta correcta D
• 28. Con que fenómenos se relaciona la taquicardia paroxística supraventricular, la cual suele cursar asintomática.
• R = Intoxicación por digitalicos, bloqueos AV y fenómeno de reentrada.
• 29. Que tratamiento se utiliza en taquicardia paroxística supraventricular en caso de estar contraindicados los antiarrítmicos
clase IV y que ha demostrado 100% de éxito?
• R = Cardioversion.
• 30. Cual es el fármaco de elección en caso de prevención de ataques de taquicardia paroxística supraventricular?
• R = DIGOXINA
• 32. En que casos no necesita tratamiento las taquicardias supraventriculares causadas por vías accesorias o síndrome de
preexitacion?
• R = En casos de no presentar palpitaciones, mareos o sincope.
• - A22-year-old woman complains of palpitations and has a regular heartbeat at a rate of 170/min, with a blood pressure of 110/70 mm Hg. The rate
abruptly changes to 75/min after applying carotid sinus pressure. Which of the following is the most likely diagnosis?
• (A) sinus tachycardia
• (B) paroxysmal atrial fibrillation
• (C) paroxysmal atrial flutter
• (D) paroxysmal supraventricular tachycardia (PSVT)
• Respuesta correcta D
• 38. Cual es el mecanismo de elección para la prevención de muerte súbita en un paciente con factores de riesgo?
• R = Desfibrilador implantado
• 48. Cual es el cuadro clínico característico de alguien con ICC con edema agudo pulmonar?
• R = DISNEA, tos, ESPUTO ROSADO, diaforesis, cianosis.
• 50. Que tratamiento se utiliza en ICC después de que los diuréticos y nitratos no mejoran la sintomatología?
• R = NISERITIDA, forma recombinante de péptido atrial natriuretico del cerebro humano.
• 54. La morfina es eficaz en el manejo de derrame pleural cardiogenico, debido a que mecanismo?
• R = AUMENTA LA CAPACITANCIA VENOSA, disminuye la presión auricular izquierda y disminuye la ansiedad.
• 56. Cuáles son los agentes más comunes para miocarditis aguda?
• R = VIRAL (COXACKIE) bacteriano, riketsias, espiroquetas, micoticos y parasitarios.
• -A 23-year-old man develops sharp left-sided chest pain, fever, and a friction rub heard at the lower left sternal
border, unaffected by respiration. The pain is also aggevated by lying down and relieved by sitting up. He is
otherwise well with no other symptoms and the remaining physical examination is normal. Which of the
following is the most likely cause for his symptoms?
• 59. Que afección sistémica es la regla para un individuo que padece Chagas?
• R = MEGAESOFAGO O MEGACOLON.
• 60. Entre las afecciones parasitarias cual es la mas frecuente de afección cardiaca?
• R = La triquinosis.
• 62. Que dato puede ser único o inicial en el EKG en MIOCARDITIS INFECCIOSA?
• R = Ectopia ventricular
• 63. Que medicamento esta indicado en el espasmo coronario inducido por la COCAÍNA?
• R = BETABLOQUEADORES Y CALCIOANTAGONISTAS
• -57 A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is
significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of
protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin.
Which of the following is the most characteristic neurologic finding associated with this condition?
• -Peripheral motor and sensory neuropathy: In addition to peripheral motor and sensory neuropathy, cardiac involvement, tongue
enlargement, gastrointestinal (GI) manifestations, and carpal tunnel syndrome are also seen in amyloidosis. The specific diagnosis requires
tissue biopsy with presence of amyloid with specific stains. In primary amyloidosis and myeloma, the amyloid protein is of the ALtype. In
reactive amyloidosis, the protein is of the amyloid Aprotein (AA) type.
• -Auscultation of the heart of a 17-year-old boy reveals an increased intensity of the pulmonary component of the
second heart sound. He complains of dyspnea on exertion but no other cardiac or pulmonary symptoms. Which of the
explanations is the most likely cause of his dyspnea?
• (A) pulmonary stenosis
• (B) aortic stenosis
• (C) MI
• (D) pulmonary hypertension
• (E) systemic hypertension
• Respuesta correcta D
• 83. Cuales son los tumores primarios del corazón mas frecuentes?
• R = MIXOMA AURICULAR el cual es un tumor benigno que puede embolizar sistémicamente y se ubica comúnmente en la aurícula derecha.
• -A 47-year-old woman has new-onset transient right arm weakness and word finding difficulty symptoms lasting 3 hours. She is also
experiencing exertional dyspnea, and had a syncopal event 1 month ago. Her echocardiogram reveals a cardiac tumor in the left atrium, it
is pendunculated and attached to the endocardium. Which of the following is the most likely cause of this lesion?
• (A) myxoma
• (B) sarcoma
• (C) rhabdomyoma
• (D) fibroma
• (E) lipoma
• Respuesta correcta A
• 85. Cuales son los datos clínicos mas frecuentes de la enfermedad de Takayasu?
• R = Soplos vasculares, PULSOS PERIFÉRICOS DISMINUIDOS y ASIMETRÍA DE LA PA DE LAS EXTREMIDADES.
• 88. Que fenómenos deben descartarse en una persona que haya cursado con enfermedad de Raynaud?
• R = 80% ESCLERODERMIA, MIOSITIS, LES, AR.
• 89. Cual es el síndrome doloroso regional o complejo tipo 1 distrofia simpática refleja?
• R = DOLOR ARDOROSO O QUEMANTE de mas duración de lo esperado POR TRAUMATISMO EN EXTREMIDAD
secundario a aplastamiento o quemadura.
• 94. Qué medidas se toman en un sujeto con choque que no responde a estímulos?
• R = DEXTROSA AL 50%, naloxona 2 ml iv. Manteniendo la diuresis horaria mayor de .5
• -A 25-year-old man complains of left precordial chest pain that radiates to the left shoulder but not down the
left arm. The pain is accentuated by inspiration and relieved by sitting up. The pain is accompanied by fever and
chills. His blood pressure is 105/75 mm Hg, pulse 110/min and regular, and temperature 37.5°C. Aside from the
tachycardia, there are no abnormal physical findings in the heart or lungs. The ECG shows STsegment elevation
in all leads except aVR and VI. On the third hospital day, the patient’s blood pressure falls, JVP rises, and he
goes into CHF. Which of the following is the most likely diagnosis?
• (A) a second pulmonary embolus
• (B) extension of a myocardial infarct
• (C) cardiac tamponade
• (D) secondary bacterial infection
• (E) rupture of a chordae tendineae
• Respuesta correcta C
• -A 56-year-old man presents with SOB, fatigue, and edema. He has also noticed weight gain, abdominal
discomfort, and distension. He has a prior history of lung cancer treated with radiotherapy to the chest. There
is no history of liver or cardiac disease in the past. On examination, he has an elvated JVP, prominent y descent
of neck veins, and positive Kussmaul’s sign. The heart sounds are normal. The CXR shows a normal cardiac
silhouette and the ECG has low voltages.
• -A 55-year-old woman with metastatic lung cancer presents with dyspnea and pedal edema. On examination,
the JVP is at 10 cm, with a negative Kussmaul’s sign. The heart sounds are diminished and the lungs have
bibasilar crackles. The ECG shows QRS complexes of variable height
• -A 55-year-old woman is recently diagnosed with amyloidosis. She is now noticing increasing SOB, fatigue, and edema. On
examination, the JVP is at 10 cm with a negative Kussmaul’s sign but prominent x and y descent. The blood pressure is 90/70
mm Hg, no pulsus paradoxus, pulse 100/min with low volume, and normal heart sounds.
• -A 60-year-old man presents with SOB, increasing abdominal distention, and lower leg edema. He has no prior history of
cardiac, renal, or liver disease. On examination, the JVP is at 8 cm with a negative Kussmaul’s sign but prominent x and y
descent. The blood pressure is 95/75 mm Hg, no pulsus paradoxus, pulse 100/min with low volume, and normal heart sounds.
There is shifting dullness of the abdomen and pedal edema. His blood glucose and hemoglobin A1C are elevated.
• 105. Que medicamentos están contraindicados en miocardiopatía restrictiva?
• Digitalicos y agonistas B adrenérgicos.
• CRITERIOS MAYORES:
• 1. Hemocultivos positivos para EI
1.1. Microorganismos típicos de EI en dos hemocultivos separados
1.1.1 ESTREPTOCOCO VIRIDANS
S. BOVIS
HACEK
1.1.2. S. Aureus o Enterococus adquiridos en la comunidad en ausencia de foco primario
1.2. Hemocultivos persistentes positivos
1.2.1. Hemocultivos extraidos con más de 12 horas de separación
1.2.2. La totalidad de tres, o la mayoría de cuatro o más hemocultivos separados
siempre que entre el primero y el último haya al menos una hora
• -A 56-year-old man presents with SOB, fatigue, and edema. He has also noticed weight gain, abdominal
discomfort, and distension. He has a prior history of lung cancer treated with radiotherapy to the chest. There
is no history of liver or cardiac disease in the past. On examination, he has an elvated JVP, prominent y descent
of neck veins, and positive Kussmaul’s sign. The heart sounds are normal. The CXR shows a normal cardiac
silhouette and the ECG has low voltages.
• -A 64-year-old presents with dyspnea and edema. He had previous coronary
bypass surgery 5 years ago, which was uncomplicated. Since then he has
had no further chest pain. On examination, his JVP is at 8 cm, with
prominent Kussmaul’s sign. The heart sounds are easily heard but there is
an early diastolic filling sound (pericardial knock).
5. Ten Fe.
BIBLIOGRAFIA
• EXARMED
• PAPADAKIS
• CTO
• HARRISON
• AMIR
• USMLE STEPS