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André Martin Mansoor

@AndreMansoor

10 Jan

1/8
A 50-y/o man presents with exertional dyspnea. The two main systems responsible for dyspnea are the heart and the lungs.

2/8
The jugular venous pulse can serve as a pivot point. It can take you toward or away from the heart. With this in mind, you evaluate the patient's neck. What do you notice?

Not only is the JVP elevated, but it appears to rise with inspiration. This is known as Kussmaul's sign

3/8
In the above video, you may have also noticed a mark on the patient's skin, just below the "a wave" in our logo. Here is the mark up close:

What is it?

Read 8 tweets

André Martin Mansoor

@AndreMansoor

4 Jan

1/6
A young man is admitted to the hospital with malaise and fever. You examine his hands and find these tender nodules.

This should generate a hypothesis.

(Heart sounds in this thread best heard with headphones or a decent computer speaker)

2/6
With your hypothesis in mind, you listen to the patient's heart. You anticipate what you might hear.

"The ears can't hear what the mind doesn't know."

3/6
Based on the holosystolic murmur at the apex that you anticipated you would hear, you diagnose the patient with mitral valve endocarditis. Two days later, his heart sounds change. Take a listen.

An additional diagnosis has now been made.

Read 6 tweets

André Martin Mansoor

@AndreMansoor

31 Dec 21

1/9
You hear an extra transient heart sound near S1. Now what?

(All sounds in this thread best heard with headphones/good speakers)

2/9
Not sure you hear three sounds? Here is normal S1 and S2 to serve as a control. There are two sounds. Listen to this clip and then re-listen to the above clip. When you do, you will hear three sounds. Two near where S1 should be, followed by S2.

3/9
So what's the differential for extra transient sounds near S1?

DDx:
Split S1
S4 gallop
Ejection click

Read 9 tweets

André Martin Mansoor

@AndreMansoor

27 Dec 20

1/

A physical exam SMASLAR in 10 tweets.

This middle-age patient was admitted several weeks ago with cardiogenic shock of unclear etiology. He is recovering well on the ward when I meet him. This is what I see:

2/

Here is another view of these vigorous carotid pulses (Corrigan's pulse). Classically associated with aortic insufficiency, there are several other causes:

1. High-output state (eg, wet beriberi, thyrotoxicosis, etc.)
2. Coarctation of the aorta

3/

I immediately think he must have aortic insufficiency. I listen, but I do not hear a diastolic murmur. Still, I evaluate his nail beds and this is what I see:

Read 11 tweets

André Martin Mansoor

@AndreMansoor

5 Jan 20

1/

On the subject of paracentesis.

2/

There are 2 main components to all procedures: cognitive aspects (indications, contraindications, complications) and technical aspects (steps of procedure, hand positioning, etc.).

Let’s start with the cognitive aspects.

3/

Indications. As with most procedures there are 2 broad indications: diagnostic and therapeutic. In order to understand the nature of the fluid and approach the broad differential diagnosis, it must be sampled. Portal HTN vs non-portal HTN. Also eval for SBP.

Read 23 tweets