Displaced PMI

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WikiDoc Resources for Displaced PMI
Articles
Most recent articles on Displaced PMI Most cited articles on Displaced PMI Review articles on Displaced PMI Articles on Displaced PMI in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Displaced PMI Images of Displaced PMI Photos of Displaced PMI Podcasts & MP3s on Displaced PMI Videos on Displaced PMI
Evidence Based Medicine
Cochrane Collaboration on Displaced PMI Bandolier on Displaced PMI TRIP on Displaced PMI
Clinical Trials
Ongoing Trials on Displaced PMI at Clinical Trials.gov Trial results on Displaced PMI Clinical Trials on Displaced PMI at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Displaced PMI NICE Guidance on Displaced PMI NHS PRODIGY Guidance FDA on Displaced PMI CDC on Displaced PMI
Books
Books on Displaced PMI
News
Displaced PMI in the news Be alerted to news on Displaced PMI News trends on Displaced PMI
Commentary
Blogs on Displaced PMI
Definitions
Definitions of Displaced PMI
Patient Resources / Community
Patient resources on Displaced PMI Discussion groups on Displaced PMI Patient Handouts on Displaced PMI Directions to Hospitals Treating Displaced PMI Risk calculators and risk factors for Displaced PMI
Healthcare Provider Resources
Symptoms of Displaced PMI Causes & Risk Factors for Displaced PMI Diagnostic studies for Displaced PMI Treatment of Displaced PMI
Continuing Medical Education (CME)
CME Programs on Displaced PMI
International
Displaced PMI en Espanol Displaced PMI en Francais
Businness
Displaced PMI in the Marketplace Patents on Displaced PMI
Experimental / Informatics
List of terms related to Displaced PMI

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Overview

• During a cardiac examination, the normal point of maximal impulse (PMI) should be routinely palpated in the left midclavicular line between the fourth and fifth ribs (normally 2-3 cm in diameter)
• The normal PMI represents the apical impulse of the left ventricle
• A displaced PMI sheds light on abnormalities of the heart, and therefore allows for a correct diagnosis

Differential Diagnosis of a Displaced PMI

In alphabetical order on 30th April 2008 ^[1]

• Aortic aneurysm
• Dilated pulmonary artery
• Left ventricular aneurysm
• Left ventricular enlargement
• Left ventricular hypertrophy
• Massive pleural effusion
• Right-sided tension pneumothorax
• Right ventricular dilation
• Right ventricular hypertrophy

Chest X Ray

• Chest X-ray is useful for the diagnosis of congestive heart failure, pneumothorax and pleural effusions

MRI and CT

• MRI and CT scan for patients with aortic dissections or aneurysms

Echocardiography or Ultrasound

• Echocardiogram assesses the presence/absence of apical aneurysm, wall thickness, ventricular function, chamber size, measurement of pulmonary artery (PA) pressure (indirectly)
• Transesophageal echocardiogram (aortic dissections or aneurysms)

Treatment

• Blood pressure control (left ventricular hypertrophy)
• Observation and diuretics (tension pneumothorax)
• Treatment of underlying etiology and diuretics (right heart failure)

Surgery and Device Based Therapy

• Needle decompression and chest tube (pleural effusions)
• Surgical correction (aortic aneurysm)

References

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker

v • d • e Circulatory system pathology (I, 390-459)
Hypertension	Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)
Ischaemic heart disease	Angina pectoris (Prinzmetal's angina) - Myocardial infarction (heart attack) - Dressler's syndrome
Pulmonary circulation	Pulmonary embolism - Cor pulmonale
Pericardium	Pericarditis - Pericardial effusion - Cardiac tamponade
Endocardium/heart valves	Endocarditis - mitral valve (regurgitation, prolapse, stenosis) - aortic valve (stenosis, insufficiency) - pulmonary valve (stenosis, insufficiency) - tricuspid valve (stenosis, insufficiency)
Myocardium	Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia
Electrical conduction system of the heart	Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation (Familial) - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome
Other heart conditions	Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)
Cerebrovascular diseases	Stroke - Transient ischemic attack - Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease
Arteries, arterioles and capillaries	Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery)
Veins, lymphatic vessels and lymph nodes	Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis)
Other	Hypotension (Orthostatic hypotension) - Rheumatic fever
See also congenital (Q20-Q28, 745-747)

v • d • e WikiDoc Research Resources for Displaced PMI (Click show to right to view)
Articles on Displaced PMI	Most recent articles on Displaced PMI • Most cited articles on Displaced PMI • Review articles on Displaced PMI • Articles on Displaced PMI in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Displaced PMI	Powerpoint slides on Displaced PMI • Images of Displaced PMI • Photos of Displaced PMI • Podcasts & MP3s on Displaced PMI • Videos on Displaced PMI
Evidence Based Medicine Regarding Displaced PMI	Cochrane Collaboration on Displaced PMI • Bandolier on Displaced PMI • TRIP on Displaced PMI
Cost Effectiveness of Displaced PMI	Cost Effectiveness of Displaced PMI
Clinical Trials Involving Displaced PMI	Ongoing Trials on Displaced PMI at Clinical Trials.gov • Trial results on Displaced PMI • Clinical Trials on Displaced PMI at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Displaced PMI	US National Guidelines Clearinghouse on Displaced PMI • NICE Guidance on Displaced PMI • NHS PRODIGY Guidance • FDA on Displaced PMI • CDC on Displaced PMI
Textbook Information on Displaced PMI	Books and Textbook Information on Displaced PMI
Pharmacology Resources on Displaced PMI	Dosing of Displaced PMI • Drug interactions with Displaced PMI • Side effects of Displaced PMI • Allergic reactions to Displaced PMI • Overdose information on Displaced PMI • Carcinogenicity information on Displaced PMI • Displaced PMI in pregnancy • Pharmacokinetics of Displaced PMI •
Genetics, Pharmacogenomics, and Proteinomics of Displaced PMI	Genetics of Displaced PMI • Pharmacogenomics of Displaced PMI • Proteomics of Displaced PMI
Newstories on Displaced PMI	Displaced PMI in the news • Be alerted to news on Displaced PMI • News trends on Displaced PMI
Commentary on Displaced PMI	Blogs on Displaced PMI
Patient Resources on Displaced PMI	Patient resources on Displaced PMI • Discussion groups on Displaced PMI • Patient Handouts on Displaced PMI • Directions to Hospitals Treating Displaced PMI • Risk calculators and risk factors for Displaced PMI
Healthcare Provider Resources on Displaced PMI	Symptoms of Displaced PMI • Causes & Risk Factors for Displaced PMI • Diagnostic studies for Displaced PMI • Treatment of Displaced PMI
Continuing Medical Education (CME) Programs on Displaced PMI	CME Programs on Displaced PMI
International Resources on Displaced PMI	Displaced PMI en Espanol • Displaced PMI en Francais
Business Resources on Displaced PMI	Displaced PMI in the Marketplace • Patents on Displaced PMI
Informatics Resources on Displaced PMI	List of terms related to Displaced PMI

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .