Se observa la configuración del tórax (tórax en quilla o en embudo) y la dinámica respiratoria. Se busca el o choque de la punta, visible en el 5º espacio intercostal, línea medio-clavicular, en condiciones normales. La presencia de un latido ectópico o hiperdinámico sugiere sobrecarga de volumen o presión.
He then examined the neck veins. With the silver penlight from his pocket, he traced the jugular pulse. It rose in a giant, cannon-like ‘a’ wave— atrial kick against a stenotic valve . He felt the radial pulse: bisferiens , a double beat, like two small hammers—classic for mixed aortic disease. semiología cardiovascular argente
“Thank you,” he mouthed. “For listening.” Se observa la configuración del tórax (tórax en
“He has combined rheumatic heart disease,” Elías said, standing up. “Mitral prolapse with regurgitation, severe aortic stenosis, and moderate aortic regurgitation. The left ventricle is alternating. He’s in decompensated failure. He needs nitroprusside and urgent valve surgery—but first, digoxin and diuretics. Now.” He then examined the neck veins