Dysrhythmias & EKG Interpretation Q 10 - Gyan Darpan : Learning Portal
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Friday, 29 April 2022

Dysrhythmias & EKG Interpretation Q 10

A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect?
     A. Left-sided heart failure
     B. Aortic regurgitation
     C. Complete heart block
     D. Pericardial tamponade

Correct Answer: D. Pericardial tamponade

A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Cardiac tamponade is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock.

Option A: Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Right ventricular alternans occur as a result of right ventricular strain, often precipitated by a pulmonary embolism or pulmonary hypertension. Other potential etiologies of right ventricular alternans include reactive airway disease, mitral stenosis, or left-sided heart failure.
Option B: Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak). The most common causes of pulsus bisferiens are mixed aortic valve disease (infective endocarditis, rheumatic heart disease, Marfan syndrome, bicuspid aortic valve) and hypertrophic cardiomyopathy with obstruction (HOCM). Pulsus bisferiens a single central pulse wave with two peaks separated by a distinct mid-systolic dip. An early component percussion wave results from rapid left ventricular ejection. The late component tidal wave represents a reflected wave from the periphery due to an artery’s recoil effect.
Option C: Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure). The physical exam is usually remarkable for bradycardia. JVP examination often demonstrates cannon A-waves owing to the simultaneous contraction of the atria and ventricles. Thus a very large pressure wave is felt up against the vein.

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