Tightening Up

Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This young woman has presented with rapidly progressive dyspnea associated with features of right sided heart failure.\n\nVery few diseases give rise to this clinical picture - these include isolated right ventricular infarction, cardiac tamponade and constrictive pericarditis.\n\nThe presence of a diffuse apical impulse and muffled heart sounds favor cardiac tamponade or constrictive pericarditis, although this is by no means definite. Further differentiation requires imaging - ideally echocardiography.\n\nHer echocardiogram shows normal systolic function, normal cardiac contractility and no wall motion abnormalities - which make right ventricular infarction very unlikely. In addition, the absence of a pericardial effusion excludes cardiac tampo"}]}

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