Auscultation of the heart reveals the normal audible cardiac cycle, which allows the clinician to assess heart rate, rhythm, and regularity. Furthermore, cardiac murmurs that have characteristic sounds within the phases of the cardiac cycle can be demonstrated (Fig. 3.81).
In the clinic
Classic symptoms of heart attack
The typical symptoms are chest heaviness or pressure, which can be severe, lasting more than 20 minutes, and often associated with sweating. The pain in the chest (which may be described as an “elephant sitting on my chest” or by using a clenched fist to describe the pain [Levine sign]) often radiates to the arms (left more common than the right), and can be associated with nausea. The severity of ischemia and infarction depends on the rate at which the occlusion or stenosis has occurred and whether or not collateral channels have had a chance to develop.
In the clinic
Are heart attack symptoms the same in men and women?
Although men and women can experience the typical symptoms of severe chest pain, cold sweats, and pain in the left arm, women are more likely than men to have subtler, less recognizable symptoms. These may include abdominal pain, achiness in the jaw or back, nausea, shortness of breath, or simply fatigue. The mechanism of this difference is not understood, but it is important to consider cardiac ischemia for a wide range of symptoms.
In the clinic
The cardiac conduction system can be affected by coronary artery disease. The normal rhythm may be disturbed if the blood supply to the coronary conduction system is disrupted. If a dysrhythmia affects the heart rate or the order in which the chambers contract, heart failure and death may ensue.
In the clinic
Ectopic parathyroid glands in the thymus
The parathyroid glands develop from the third pharyngeal pouch, which also forms the thymus. The thymus is therefore a common site for ectopic parathyroid glands and, potentially, ectopic parathyroid hormone production.
In the clinic
Large systemic veins are used to establish central venous access for administering large amounts of fluid, drugs, and blood. Most of these lines (small-bore tubes) are introduced through venous puncture into the axillary, subclavian, or internal jugular veins. The lines are then passed through the main veins of the superior mediastinum, with the tips of the lines usually residing in the distal portion of the superior vena cava or in the right atrium.
Similar devices, such as dialysis lines, are inserted into patients who have renal failure, so that a large volume of blood can be aspirated through one channel and reinfused through a second channel.
In the clinic
Using the superior vena cava to access the inferior vena cava
Because the superior and inferior venae cavae are oriented along the same vertical axis, a guidewire, catheter, or line can be passed from the superior vena cava through the right atrium and into the inferior vena cava. This is a common route of access for such procedures as: transjugular liver biopsy, transjugular intrahepatic portosystemic shunts (TIPS), and insertion of an inferior vena cava filter to catch emboli dislodged from veins in the lower limb and pelvis (i.e., patients with deep vein thrombosis [DVT]).
In the clinic
Coarctation of the aorta