Effect of the Valsalva Maneuver on the Second Heart Sound.

The Valsalva maneuver should be incorporated into the routine of auscultation even when a murmur is absent. Valsalva release affects the second heart sound. It is particularly helpful during detailed, non-perfunctory auscultation in patients with bundle branch block.

Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization.

Objective: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc). We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).

Methods: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and pulmonary function tests (PFT).

Practical cardiac auscultation.

This article focuses on the practical use of the stethoscope. The art of the cardiac physical examination includes skillful auscultation. The article provides the author's personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs.

Pulmonary vein edema in a patient undergoing coronary artery bypass graft surgery and concomitant radiofrequency ablation for chronic atrial fibrillation.

The syndrome of pulmonary vein stenosis characterized by pulmonary hypertension, dyspnea on exertion, and right heart failure, is a well-described complication of percutaneous ablation approaches, but has not been described with surgical approaches. We describe the case of a patient who developed localized edema at the pulmonary vein-left atrial junction after undergoing intraoperative radiofrequency ablation for chronic atrial fibrillation as part of CABG for severe triple vessel disease. The pulmonary vein edema resolved within 10 months suggesting that it may be a clinically silent and self-resolving phenomenon.

P-wave amplitude and pulmonary artery pressure in scleroderma.

Background And Purpose: Scleroderma is an immune-mediated disease characterized by excess deposition of collagen leading to microvascular occlusion. Morbidity and mortality are often secondary to pulmonary hypertension from injury to pulmonary microvasculature and interstitial lung disease. This study correlated P-wave findings on the 12-lead electrocardiogram (ECG) with mean pulmonary artery pressure (mPAP) measured by right heart catheterization in patients with scleroderma.

Persistence of normotension after discontinuation of lifestyle intervention in the trial of TONE. Trial of Nonpharmacologic Interventions in the Elderly.

Background: Weight loss and sodium reduction programs are effective in treating hypertension, but there is little information about the persistence of the benefit after discontinuation of the intervention.

Methods: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) was a four-center controlled clinical trial of weight loss, reduced sodium intake, or both in maintaining normotension after withdrawal of antihypertensive drug therapy in older men and women whose hypertension was controlled with a single antihypertensive medication. Information on maintenance of normotension without need for drug therapy was obtained on 222 of 223 participants at the Robert Wood Johnson Medical School clinical center on average of 48.