Presuming there is a carotid jugular fistula created by trauma at approximately the level where the common carotid separates......... could there be unequal external carotid pulses and diminished or absent internal carotid pulse on injured side? Would valves in the jugular be able to direct arterial blood flow into return tract without JVD on injured side? Possible increased inflow pressure to right ventricle cause dilation ? Given existing saphenous vein graft of RCA might dilation of RV affect lie of graft....nodal artery insufficiency.....bradycardia? Increasing demand on LV to compensate output?
I know. Tough to say... but possible?
Thanks for thoughtful answer....please.
Wow this is a very technical question requiring a LOT of thought, but at the same time interesting. For one thing, the answers to your questions would depend, and by substantially different, by the actual diameter of the fistular. If very small, I would suspect a patient would go for months or years before the correct diagnosis is found. However, if large, then this would be a totally different scenario. I think pulses would be felt on all vessels, but it would take an echo doppler to see the shunting. As you point out, there are valves involved on the venous side, and this would mean shunting of blood from the arterial side to venous would affect pressure into the right atrium. I think tachycardia would result and eventual cardiac failure would be imminent. The sooner the vessels are separated the better. There have been cases where medication has been attempted for heart failure with no benefits, but as soon as the fistula is closed off, the heart has recovered. Having given this a lot of thought, I can't help but wonder if the diastolic pressure would greatly decrease. I'm not a Doc or professional in medicine but I thank you for such an interesting question.
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