Eisenmenger’s syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

The general examination of patients with Eisenmenger's syndrome may show cyanosis, dermal changes, clubbing, peripheral edema, and abdominal swelling. Cardiac examination may show A wave dominant jugular venous pulse, right ventricular heave, high-pitched early diastolic murmur of pulmonary insufficiency, right-sided S4, pulmonary ejection click, single palpable S₂, and loud P₂.

Physical Examination

The physical examination of patients with Eisenmenger's syndrome may show the following:

Appearance of the Patient

• Patients with Eisenmenger's syndrome usually appear lethargic and cyanotic.

Vital Signs

• Tachycardia
• Tachypnea
• Postural hypotension

Skin

Skin examination of patients with Eisenmenger's syndrome usually shows:

• Plethora
• Livedo reticularis
• Profound acrocyanosis
• Urate depositions
• Ecchymosis
• Ischemic skin ulcerations

HEENT

• HEENT examination of patients with Eisenmenger's syndrome is usually normal.

Neck

• Jugular venous distension
• Hepatojugular reflux

Lungs

• Pulmonary examination of patients with Eisenmenger's syndrome is usually normal.

Heart

• Jugular venous pulse wave may be A wave dominant
• Precordial palpation reveals a right ventricular heave
• High-pitched early diastolic murmur of pulmonary insufficiency
• Right-sided S4
• Pulmonary ejection click
• Single palpable S₂
• Loud P₂

Abdomen

• Hepatomegaly
• Jaundice
• Right upper abdominal quadrant tenderness

Back

• Back examination of patients with Eisenmenger's syndrome is usually normal.

Genitourinary

• Genitourinary examination of patients with Eisenmenger's syndrome is usually normal.

Neuromuscular

• Neuromuscular examination of patients with Eisenmenger's syndrome is usually normal.

Extremities

• Cyanosis
• Clubbing
• Peripheral edema

Nail clubbing of fingers in a patient with Eisenmenger's syndrome. Case courtsey of Ann McGrath [Public domain].