{"id":1687,"date":"2020-05-18T10:08:03","date_gmt":"2020-05-18T17:08:03","guid":{"rendered":"https:\/\/up.physicaldiagnosispdx.com\/up\/?page_id=1687"},"modified":"2021-03-03T15:04:23","modified_gmt":"2021-03-03T23:04:23","slug":"friedrichs-sign-2","status":"publish","type":"page","link":"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/friedrichs-sign-2\/","title":{"rendered":"Friedreich&#8217;s Sign"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row css=&#8221;.vc_custom_1592016370834{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]<span style=\"font-size: 14pt;\">The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds to the combination of right atrial relaxation and depression of the atrial floor during ventricular contraction, is normally dominant. The y descent occurs as a result of passive ventricular filling during early diastole. A sharp and deep y descent that becomes more dominant than the x descent is known as Friedreich\u2019s sign. It is associated with constrictive pericarditis and restrictive cardiomyopathy.<\/span><br \/>\n<figure id=\"attachment_1658\" aria-describedby=\"caption-attachment-1658\" style=\"width: 150px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/card-tutorial\/#Friedreichs_Sign\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-1658 size-thumbnail\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png 150w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-300x300.png 300w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308.png 512w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1658\" class=\"wp-caption-text\">&nbsp;<\/figcaption><\/figure>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 1:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient was admitted to the hospital with cardiac tamponade. After the effusion was drained, he developed signs of pericardial constriction, including Friedreich&#8217;s sign. The cause of the pericardial effusion was never determined, but in some cases, particularly in association with tamponade, transient acute constriction can ensue for days to weeks following the initial pericardial insult as a result of reversible inflammation and edema (transient constrictive pericarditis). These videos demonstrate a sharp and deep y descent of the jugular venous waveform. Note the comparatively smaller intervening x descent, which is normally the dominant trough of the jugular venous waveform.<\/span><\/p>\n<p><a href=\"https:\/\/casereports.bmj.com\/content\/2018\/bcr-2018-226820.short\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 14pt;\">Video courtesy of BMJ case reports: &#8220;Friedreich&#8217;s sign&#8221;<\/span><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592016399898{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Friedreich&#8217;s sign<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472321164?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Annotated<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472320381?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 2:<\/h1>\n<p><span style=\"font-size: 14pt;\">Middle-aged man with myelodysplasia, who had developed acute pericarditis several months ago, and now has effusive-constrictive pericarditis. In this video, he was in sinus tachycardia with requent premature atrial contractions, but you can appreciate his rapidly collapsing and deep Y waves<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/507688156?loop=1\" width=\"320\" height=\"600\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/507686549?loop=1\" width=\"640\" height=\"564\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1592016370834{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds to the combination of right atrial relaxation and depression of the atrial floor during ventricular contraction, is normally dominant. The y descent occurs as a result of passive ventricular filling during<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":3164,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"page-templates\/page_PDXPDX-full-width.php","meta":{"nf_dc_page":"","_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-1687","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1687","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/comments?post=1687"}],"version-history":[{"count":4,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1687\/revisions"}],"predecessor-version":[{"id":10391,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1687\/revisions\/10391"}],"up":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/3164"}],"wp:attachment":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/media?parent=1687"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}