The answer is c Fauci 14e pp 13951396 Dissection of the

aorta occurs when the intima is interrupted so that blood enters the wall of the aorta and separates its layers, forming a second lumen. It is almost always fatal if left undiagnosed, but with prompt treatment most patients survive. Anything that weakens the media can lead to dissection, but hypertension is the most common risk factor. Aortic dissection is a major cause of morbidity and mortality in Marfan syndrome. Other etiologies of dissection include cystic medial necrosis (described in patients with bicuspid aortic valves), syphilis, Ehlers-Danlos syndrome, trauma, and bacterial infections. Patients often have murmurs due to aortic insufficiency. The treatment of dissection is to control the blood pressure and heart rate to prevent extension of the dissection. A tracheal tug is considered positive if the pulsating aorta is felt when the trachea is pulled upward.

169. The answer is b. (Seidel, 4/e, p 421.) The activity of the right side of the heart is transmitted normally through the jugular veins as a visualized pulse. The a wave is due to venous distension caused by atrial contraction. It is the most dominant wave, especially during inspiration. The a wave is not present during atrial fibrillation. Exaggerated a waves are called cannon waves and are due to the right atrium contracting against increased resistance (i.e., PS, TS, complete heart block). The c wave of the venous pressure curve occurs as a result of ventricular contraction, which forces the TV back toward the atrium. For that reason it is simultaneous with the carotid pulse. If the TV is incompetent, the c wave will be increased. The v wave is the result of atrial filling while the AV valves are closed. The v wave becomes large with TR. The downward x slope is caused by atrial filling and the y slope is caused by the open TV and the rapid filling of the ventricle.

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