Page 43 - Clinical Pearls in Cardiology

Arterial Pulse and Blood Pressure 31

3. What are the common noncardiac pathological causes
of bradycardia?
Hypothyroidism, raised intracranial pressure and
obstructive jaundice are the three important noncardiac
pathological conditions associated with bradycardia. The
physiological mechanisms include the following:
• There is a decrease in both the number and sensitivity
of beta receptors to catecholamines in hypothyroidism
• There is activation of the Cushing’s reflex in raised
intracranial pressure
• There is increased concentration of bile salts in the
blood which inhibits the SA node in obstructive
jaundice.
4. What is meant by locomotor brachii and what is
Osler’s sign?
‘Locomotor brachii’ is a sign of thickened vessel wall.
It is used to denote the vigorous dancing movements
of the thickened and tortuous brachial artery in the
antecubital fossa which is well visible in a slightly flexed
elbow joint. The thickening of the vessel wall is either due
to accelerated atherosclerosis or due to Monckeberg’s
arteriosclerosis. Monckeberg’s arteriosclerosis is a form
of vessel hardening seen in people over 50 years of age
and diabetics. This condition is characterized by calcium
deposition in the middle layer of the walls of medium-
sized vessels.
Once an arterial pulse is obliterated by applying
pressure over the proximal part of the artery or by
inflating the sphygmomanometer cuff, normal arterial
walls cannot be palpated. But arteries with thickened
walls can be felt like cords, and can be rolled under the
fingers. This is referred to as the Osler’s sign and is helpful
in detecting pseudohypertension.