Moffitt Cardiology Report 4/26: Clubbing and VT

Clubbing: turns out there is a framework for thinking about this

  • Acquired (usually what we are dealing with in internal medicine)
    • Bilateral
      • Pulmonary: ILD, lung CA, infections
      • Cardiovascular: CHF, cyanotic congenital heart diseases
      • Extrathroacic: IBD is the main one, can also be seen in liver disease, GI neoplasms
    • Unilateral: think about local vascular lesions (shunt, AV fistula, aneurysm, lymphadenitis that affects the perfusion of one hand)
  • Congenital: there are genetic mutations such as primary hypertrophic osteoarthropathy that can cause this

 

Miscellaneous cardiology pearls

  • R axis deviation: when you see this, first think could there be lead misplacement (look at the P wave axis) and consider if there are any chest wall deformities
  • Differential cyanosis (i.e. normal upper extremities, cyanotic lower extremities): patent PDA + a R to L shunt
  • PFO: usually detected with TTE + bubble. If you have a high suspicion and the bubble is negative, you may need to have the bubbles injected through a lower extremity IV due to the way the PFO is oriented in the atrial septum (think of it like a tunnel or flap)

 

VT vs SVT with aberrancy:

If you need a reminder of the Brugada criteria and how to distinguish VT vs SVT with aberrancy, check out one of our favorite medical blogs, Life In the Fastlane for this handy guide with ECG examples!

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