A patient we had said he noticed when he worked out he would get dizzy. He went through a battery of tests and they finally came to the conclusion that it was subclavian steal syndrome. Can you explain this?
Subclavian steal syndrome is a lesion in the subclavian artery just before the take-off of the vertebral artery. When your patient exercises using that arm, blood is being taken from the vertebral to supply the subclavian. The lack of blood flow to the vertebral causes your patient to get dizzy and he may even have syncopal episodes. Angioplasty can be done in the lesion to allow blood flow back to the vertebral artery, relieving your patient™s syncopal or near syncopal episodes.
 
Reading a patient™s chart for a case study I had to do, I came across Graham Steele murmur. What is this?
The Graham Steele murmur is a heart sound heard in patients with mitral stenosis. This is best heard over Erb™s point, which is at the third intercostal space at the left sternal border. Most mitral stenosis cases are caused by rhumatic fever, but may also be caused by pulmonary hypertension, SLE, infective endocarditis and can also be congenital. Other test diagnostic tools we have to help diagnose mitral stenosis are TEE (Transesophogeal Echo), chest x-ray and LV grams also work. MS can be treated medically to help relieve the heart failure symptoms should they progress that far, mitral valvoplasty and surgical correction.

Clarification: To make a clarification for our readers, in reference to last month™s commentary in this section, the term ˜button pusher™ does not refer to Rad Techs. It was used to refer to anyone working in the lab who is not providing the quality of care cardiac patients should be getting. Whether this means someone who does not care to intelligently record data for physicians to use in their diagnosis and treatment, or someone who when they realize that they are not sure of something, stay quiet instead of asking. Anyone who is indifferent while working in the cath lab should consider another field that safely allows this attitude. Our patients deserve better.

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Submit your question to:
Jason Wilson, RCIS
Ellis Hospital Clinical Instructor
Schenectady, New York
hrtfixr7@yahoo.com