CardiovascularCorner
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This patient's neck tells the diagnosis. Can you name the clinical sign?
CardiovascularCorner34,336 görüntüleme • 23 gün önce
What's the diagnosis based on this echocardiographic video?
CardiovascularCorner13,503 görüntüleme • 28 gün önce
1:50
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Surgical Implantation of a Bioprosthesis in the Aortic Position
CardiovascularCorner24,792 görüntüleme • 3 ay önce
Woltman sign, classically seen in myxoedema, refers to a delayed relaxation of a deep tendon reflex, most easily appreciated at the Achilles tendon. When the ankle jerk is tested, the initial plantar flexion is normal, but the foot lingers, returning slowly to its resting position. This lingering, “hung-up” response is the hallmark of the sign. In hypothyroidism, this happens because thyroid hormone deficiency interferes with calcium reuptake in slow-twitch muscle fibres. As a result, muscles take longer to contract and relax. While this isn’t true myotonia, the reflex was historically labelled “pseudomyotonic” because of its similar appearance. The same underlying problem explains the patient’s constipation. Low thyroid hormone levels slow gastrointestinal motility, reflecting the broader pattern of physiological slowing that also affects neuromuscular function. Historical and clinical context Woltman sign was formally described at the Mayo Clinic in the 1920s and quickly became linked to hypothyroid neuromuscular dysfunction. For many years, it was considered almost pathognomonic of untreated myxoedema. Even today, it can serve as a useful bedside clue, especially in patients who also complain of fatigue, cold intolerance, weight gain, bradykinesia, or general slowing. That said, the sign is not entirely specific. Delayed reflex relaxation can also be seen in elderly individuals with normal thyroid function, in patients taking β-blockers, and in conditions such as anorexia nervosa, diabetes mellitus, or late pregnancy. Because of this, Woltman sign is now best regarded as a suggestive finding rather than a definitive one. Clinical takeaway When constipation is paired with a delayed ankle reflex relaxation, hypothyroidism should be high on the differential, and thyroid function tests are warranted. Even in the age of modern lab diagnostics, Woltman sign remains a classic physical finding,one that highlights the intimate connection between endocrine function and the neuromuscular system. Further reading:
CardiovascularCorner26,615 görüntüleme • 6 ay önce
Apical 4-chamber view: a single window that maps cardiac anatomy and relationships. How to obtain it: 🔵 Place the transducer at the point of maximal impulse (LV apex) 🔵 Keep the probe index marker directed toward the patient’s left side (≈3 o’clock) 🔵 Aim the beam toward the base of the heart (toward the right shoulder) 🔵 Fine-tune tilt/rotation until all four chambers are symmetric and the septum is vertical From the LV apex, you see all four chambers in one plane (LV, RV, LA, RA) with correct orientation (apex near the probe, atria deeper). Key structures: 🔵 LV: papillary muscles, chordae, anterior & posterior mitral leaflets 🔵 RV: moderator band, anterior & septal tricuspid leaflets 🔵 Interatrial septum and ventriculoatrial septum (LV–RA separation) 🔵 Right superior pulmonary vein entering the LA near the septum 🔵 Descending aorta seen posterior/lateral to the LA High-yield pearl: The tricuspid valve annulus is normally positioned more apically than the mitral, an important landmark in structural assessment.
CardiovascularCorner12,333 görüntüleme • 2 ay önce
0:39
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Watch this remarkable video demonstrating hemopericardium on autopsy.
CardiovascularCorner16,205 görüntüleme • 4 ay önce
