Triangle of dysplasia in arrhythmogenic right ventricular dysplasia (ARVD)
Pathological features of arrhythmogenic right ventricular dysplasia (ARVD), namely the replacement of righ ventricular wall myocardium by fat and fibrous tissue and aneurysms are seen at right ventricular apex, posterior free wall and outflow tract. These regions together constitute the triangle of dysplasia.
What are the situations in which phase IV of Korotkoff’s sounds are used to measure the diastolic blood pressure?
Phase IVdiastolic pressure is measured in all hyperdynamic circulatory states which include pregnancy, children, aortic regurgitation, thyrotoxicosis, anemia and beriberi.
Ankle brachial index
Both upper limb brachial blood pressures are measured and the mean is taken. Then the ankle blood pressure is taken by tying the cuff on the calf and either auscultating the posterior tibial or using the Doppler probe over the dorsalis pedis artery. Normal ratio between the ankle blood pressure and brachial blood pressure is more than 1; less than 0.9 is taken as evidence of peripheral vascular disease.
Osler’s sign / manouver
Radial artery is palpable even after occluding the brachial artery by local pressure in elderly with thickened vessel wall and is taken as a positve Osler’s sign. Alternatively three fingers can used over the radial artery. Proximal and distal fingers are used to occlude the flow from radial artery and the retrograde flow from the ulnar artery through the palmar arch. Middle finger is used to assess the thickening of the radial artery vessel wall. This method is also known a trisection. Thickened vessel wall indicates a chance for pseudohypertension due to difficulty in compressing the vessel with an externally applied blood pressure cuff. Intra arterial pressure recording will be normal in psuedohypertension, which is more common in elderly.