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ما هي علامة هيل hill ؟


ما هي علامة هيل hill ؟

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ما هي علامة هيل hill ؟Very Happy

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Secrets physical diagnosis
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مالي كتيير متأكد بس لح حاول
نتيجة لقصور الصمام الأبهري
فيحدث زيادة كبيرة في الفرق بين ضغط الدم الشرياني الانقباضي بين الطرفين العلويين والسفليين
في الحالة الطبيعية يكون الضغط في الطرفين السفليين أعلى بحوالي 10-20 ملم ز
أما هنا فيكون الضغط في الطرفين السفليين أعلى بحوالي 60-100 ملم ز

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Inspector
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صحيح....

uptodate's picture
uptodate
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بصراحة مالي متأكد لأنو ما لي كتيير فهمان الآلية ممكن مساعدة؟؟

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Inspector
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هو عبارة عن ARTIFACT

ويطالبون بازالته من معايير اتشخيص

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uptodate
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باختصار ..

Current Medical Diagnsosi & Treatment 2008 wrote:
Cardiology: Aortic Regurgitation (Chronic Regurgitation): Clinical Findings: Symptoms and Signs

In younger patients, the increased stroke volume may summate with the reflected wave from the periphery and create an even higher systolic pressure in the extremity compared with the central aorta. Since the peripheral bed is much larger in the leg than the arm, the BP in the leg may be over 40 mm Hg higher than in the arm (Hill's sign).

واذا بدك تفصيل زيادة Eye-wink ..
اتفضل ..

THE ART AND SCIENCE OF CARDIAC PHYSICAL EXAMINATION (2006) wrote:
p.43 and 44

HILL’S SIGN

This sign is elicited by measurement of the systolic blood pressure in the arm and the
leg simultaneously or in very quick succession. It must be emphasized that the
Hill’s sign refers to systolic blood pressure differential as obtained by indirect blood
pressure measurements
using the traditional cuff. The pressure is obtained in the usual
way at the arm over the brachial artery. The pressure in the leg can be elicited over the
popliteal artery or at the ankle by palpation of the posterior tibial artery. Intra-arterial
pressure recordings at the femoral level are not the way to look for this difference
accurately
. The reason for this is that the femoral artery is probably not peripheral
enough to show this exaggerated effect.

Normally the peripheral pressures are usually amplified due to the muscular nature of
these vessels, allowing rapid transmission of the pulse wave in both directions resulting
in summation of the reflected with the peak of the incident wave. This peripheral amplification
is usually more pronounced in the leg
than in the arm. In normal subjects this
difference in peak pressure between the arm and the leg is in the order of 15–20 mmHg.
This difference may be markedly exaggerated in patients with significant aortic regurgitation.

A difference of 20–40 mmHg in peak pressure can easily be seen in other conditions
with wide pulse pressures (e.g., thyrotoxicosis, anemia, fever, or Paget’s disease)
. A
difference of between 40 and 60 mm Hg is associated with a moderate degree of aortic
regurgitation
, whereas an excess of 60 mmHg is usually indicative of moderately severe
aortic regurgitation
. Hill’s sign is therefore somewhat related to the degree of aortic
regurgitation and useful in following the patients with aortic regurgitation assuming, of
course, there is no significant peripheral arterial disease.

( Embarrased ما كنت بدي حط الباقي بس حطينا وحطينا فهي بقية الفقرة من نفس الكتاب Embarrased )

The blood pressure differential between the arm and the leg is probably multifactorial
in origin even in normal subjects:
1. The reflecting sites in the lower extremities are probably more than in the arm.
2. The vessels of the lower extremities are probably more muscular.
3. It is known that the age-related change in the compliance of the arteries is less in the
upper limb vessels than in the lower limb vessels (36,37).
4. The upper arm vessels tend to arise anatomically at approximately 90º angle from the
aortic arch. The diameter of these vessels being smaller than the aorta, the relative rapid
flow in the aortic arch may cause a Venturi effect of relative suction on these cephalobrachial
vessels. This may tend to reduce the net effect of peripheral amplification of
pressures caused by reflection. This effect of suction can be demonstrated in the side arm
of a tap by running water through it when the side arm is of a smaller diameter and at
right angles to the direction of water flow.
This concept derives support from the fact that when direct impact pressure gets
transmitted preferentially to the orifice of the innominate artery, as it happens in
supravalvular aortic stenosis, the pressure is actually higher in the right arm supplied by
that vessel. Presumably here, the Venturi effect of reduction in lateral pressure does
not apply since the direct impact pressure of the jet gets directed preferentially towards
the orifice due to the anatomical nature of the stenosis.
5. In aortic regurgitation, the increased momentum of ejection will produce larger-amplitude
incident pressure wave. The increased momentum of ejection as well as the increased
duration of ejection may in fact alter the harmonic components of the wave. It has been
shown that peripheral amplification is less with lower frequencies than with higher frequencies
of the pressure pulse wave. It has been suggested, therefore, that peripheral
amplification is generally less in aortic regurgitation. While these may be valid,
it is known that in echo Doppler measurements of pure aortic regurgitation, the aortic
outflow velocity is quite variable. Sometimes it can be quite high without the presence of
any stenosis. In patients with aortic regurgitation and high velocities of flow in the aortic
arch, one can expect exaggerated result from the Venturi effect. This may explain variations
seen in the sensitivitiy of the Hill sign in patients with aortic regurgitation. In patients
who have a positive Hill’s sign, it becomes useful in their long-term follow-up.

وما تواخذونا Embarrased

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