Case 31 Cardiology

Head bobbing

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

Have you ever made a cardiac diagnosis while standing behind a patient’s head? What do you notice?

Clue 2

Here’s another angle.

Clue 3

If you looked more closely at his neck, you might see this (from a different patient with the same condition):

Clue 4

This abnormality of the jugular venous pulse is known as Lancisi’s sign (or CV fusion). Here is an annotated version. Follow the cursor along the venous tracing as it syncs with the action in the patient’s neck.

Clue 5

And if you listen over the left lower sternal border, you might hear this:

Clue 6

Note the intensity of the murmur goes up and down in concert with tidal breathing. Carvallo’s sign describes the increase in intensity of a right-sided murmur with inspiration. (Headphones are best)

Reveal next