Herbert L. Fred, MD and Hendrik A. van Dijk, Wiki Commons
which demonstrates the type of difference I saw in my patient (normal on right, SVC on left). My patient however was female and smiled more!
Anyway, lets refocus on points to learn for the MRCP exam:
Features of SVC obstruction:
- swollen face/arm
- engorged veins
There is a rather nice test called Pemberton's Test which involves asking the patient to lift their arms above their head for >1 min and watch for increasing plethora/cyanosis, raised JVP and listen for stridor (that sound every doctor wants to induce in their patient...) If these things occur it is a positive Pembertons test and suggestive of SVC obstruction.
Causes of SVC obstruction include:
- lung cancer
- thymus malignancy
- thrombus around central line
Treatment is surgical, with dexamethasone whilst awaiting this.
Lets return to the small-squared world of the ECG to consider causes of a long PR...