Cardiac amyloidosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]; Cafer Zorkun, M.D., Ph.D. [4]; Lakshmi Gopalakrishnan, M.B.B.S. [5]

Overview

Cardiac amyloidosis is difficult to diagnose. More than 50% of the patients with cardiac amyloidosis present with signs and symptoms suggestive of right heart failure. Common physical exam findings include elevated jugular venous pressure, third heart sound and pedal edema.

Physical Examination

Vitals

Blood Pressure

The blood pressure may be low or may drop when rising to a standing position (orthostatic hypotension). Orthostatic hypotension is typically observed among patients with kidney involvement. Low cardiac output and/or inappropriate peripheral vasodilation can also contribute to hypotension.

Head and Neck

Elevated jugular pressure
Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.
Macroglossia
Abnormal phonation

Extremities

Pedal edema

Abdomen

Hepatomegaly may be present in the setting of right heart failure
Ascites may be present in the setting of right heart failure
Splenomegaly is rare

Heart

Auscultation

Third heart sound
Fourth heart sound
Arrhythmias ^[1]
Auscultation may also reveal rales, heart murmurs, and/or other pathologic heart sounds.
In patients with valvular heart disease involvement, murmurs of mitral and tricuspid regurgitation may be heard.

References

↑ Rapezzi C, Perugini E, Salvi F, Grigioni F, Riva L, Cooke RM, Ferlini A, Rimessi P, Bacchi-Reggiani L, Ciliberti P, Pastorelli F, Leone O, Bartolomei I, Pinna AD, Arpesella G, Branzi A (2006). "Phenotypic and genotypic heterogeneity in transthyretin-related cardiac amyloidosis: towards tailoring of therapeutic strategies?". Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis. 13 (3): 143–53. doi:10.1080/13506120600877136. PMID 17062380. Retrieved 2012-02-13. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[pmid17062380-1] Rapezzi C, Perugini E, Salvi F, Grigioni F, Riva L, Cooke RM, Ferlini A, Rimessi P, Bacchi-Reggiani L, Ciliberti P, Pastorelli F, Leone O, Bartolomei I, Pinna AD, Arpesella G, Branzi A (2006). "Phenotypic and genotypic heterogeneity in transthyretin-related cardiac amyloidosis: towards tailoring of therapeutic strategies?". Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis. 13 (3): 143–53. doi:10.1080/13506120600877136. PMID 17062380. Retrieved 2012-02-13. Unknown parameter |month= ignored (help)

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