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10/9/16 6:55 pm
Alternative thoughts on the constriction explanation and by no means a board issue (reference The Pericardium by Ralph Shabetai 2003, chapter on Constrictive Pericarditis): In constriction the venous return would not increase with inspiration- Kussmaul sign being one manifestation of pericardial restraint due to constriction. Pulm Venous pressures would fall more than LV pressures during inspiration ( since pulm veins are extra pericardial and LV is not) so the pressure gradient of LA to LV flow goes down, the LV volume does not get to increase and the septum bulges to the LV in consequence of that small LV. In tamponade, while this mechanism also plays a role, a second mechanism is considered important for small LV volumes. Inspiratory increase of venous return will occur as in normal individuals, thus inspiratory RV volume will increase and the septal bulge to LV is a consequence of active RV volume increase. The septal bulge will limit LV volume. Your thoughts?
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