Tuesday, May 4, 2010

Answer this Case

A 65-year-old man collapses and is brought into the casualty department. Chest X-ray shows an increase in the cardiothoracic ration but clear lung fields. He is found to have decreased arterial pressure, increased central venous pressure, and faint heart sounds .
What is the most likely diagnosis?

a) Cardiogenic shock
b) Mitral regurgitation
c) Pericardial tamponade
d) Pulmonary embolism
e) Ventricular septal defect

The correct answer is C

Pericardial tamponade classically results in the acute cardiac compression triad of Beck, which consists of decreased arterial pressure, increased central venous pressure, and distant heart sounds . Although clearly pathognomonic for tamponade, Beck's triad occurs in only 10% of individuals with pericardial tamponade

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How to avoid heat-related illnesses

To keep it cool during hot-weather exercise, keep these basic precautions in mind:

* Take it slow . If you're used to exercising indoors or in cooler weather, take it easy at first. As your body adapts to the heat, gradually increase the length and intensity of your workouts. If you have a chronic medical condition or take medication, ask your doctor if you need to take additional precautions.
* Drink plenty of fluids . Your body's ability to sweat and cool down depends on adequate rehydration. Drink plenty of water while you're working out — even if you don't feel thirsty. If you're planning to exercise intensely or for longer than one hour, consider sports drinks instead. These drinks can replace the sodium, chloride and potassium you lose through sweating. Avoid drinks that contain caffeine or alcohol, which actually promote fluid loss.
* Dress appropriately . Lightweight, loosefitting clothing promotes sweat evaporation and cooling by letting more air pass over your body. Avoid dark colors, which can absorb the heat. A light-colored hat can limit your exposure to the sun.
* Avoid midday sun . Exercise in the morning or evening — when it's likely to be cooler outdoors — rather than the middle of the day. If possible, exercise in the shade or in a pool.
* Wear sunscreen . A sunburn decreases your body's ability to cool itself.
* Have a backup plan . If you're concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building.