12.12.13 Ward notes

Tricuspid incompetence

• • Causes

    • Rheumatic fever

    • Pulmonary HTN

    • Infective endocarditis

  • Murmur

    • Loudest on inspiration

    • LLSB

    • Radiates to the liver

  • Other signs

    • Liver pulsation

      • But cf AVM and hepatoma

    • Raised JVP

TPMT

• • Thiopurine methyltransferase

  • Used to metabolise thioprines

    • 6-mercaptopurine

    • Azathioprine

    • 6-thioguanine

  • Check levels before starting therapy

    • Low activity in 10%

    • Absent in 0.3%

Femoral bruits

• • Traube's

    • "Pistol-shot"

    • Aortic regurgitation

  • Duroziez's sign /murmur

    • "To and fro" bruit over the femoral artery resulting from manual pressure applied over the femoral artery while listening with the diaphragm of the stethoscope

    • Aortic regurgitation

Campbell de Morgan spot

• • AKA cherry haemangiomas, senile angiomas

  • Common, benign skin lesions of middle to older age, formed by proliferating, dilated capillaries and postcapillary venules

  • Cause remains unknown

  • Visual appearance:

    • 1-3 mm diameter macules which may become larger papules over time

    • Typical bright cherry red colour but can appear violaceous

    • They are non-blanching

Notes

• • Breathing and heart sounds

    • Inspiration => Right side

    • Expiration => Left side

  • Cannon A waves are INTERMITTENT

  • Split skin graft - Front of thigh, buttock

  • (Un)folding of the aorta pushes the carotids up => Visible pulsation in the neck

  • Tacrolimus = FK-506

  • Wide/narrow pulse pressure => AS / AR