Dear Abraham Verghese,
Today I examined a patient with HOCM. I then examined a patient with tricuspid regurgitation and atrial flutter w 2:1 conduction.
The first patient had the most beautiful murmur and it changed just as expected with standing and squatting. (I tried Valsalva but she couldn't hold it for long enough.
The second patient had:
1. regular tachycardia
2. funny thick blood vessel w shiny middle on R funduscopic exam
3. JVD to the earlobe with giant V waves
4. diagonal earlobe crease consistent w atherosclerosis
5. loud P2
6. there must have been a murmur, although I couldn't hear it (but then my hearing sometimes seems to be going and I know Turner's is associated w sensorineural hearing loss)
7. abdominal distension w +ve fluid thrill
8. pulsatile liver
9. b/l pitting edema to the knees, worse on the L
Beat that in just two new patients!
Sincerely,
Mim.
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