Lutembacher's syndrome physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S
Overview
Physical Examination
The physical findings in an adult with Lutembacher's syndrome depends on:
- Size of the atrial septal defect
- Degree of left-to-right shunt
- Pressure in pulmonary vasculature
- Severity of the mitral stenosis
- Distensibility of the right ventricle
- Other associated anomalies such as tricuspid regurgitation, aortic stenosis
Cardiac examination
Inspection
- Precordial bulge: The left-to-right shunting of blood causes right atrial enlargement that can present as a precordial bulge. The precordial bulge can cause a counter development of Harrison's groove that are horizontal depressions along the sixth and seventh costal cartilages at the lower margin of the thorax where the diaphragm attaches to the ribs.
- Precordial lift: An increased left-to-right atrial shunt can cause a hyperdynamic right ventricular flow that can be seen as precordial lift on inspection.
Palpation
- Right ventricular impulse: An increased left-to-right atrial shunt can cause a hyperdynamic right ventricular impulse or heave. The heave can be best palpated at the left sternal border or the subxiphoid area.
- Pulmonary artery pulsations: Pulsatile, enlarged pulmonary artery pulsation can be felt at the second left intercostal space. These are more pronounced in patients with large left-to-right shunts. Patients with obstruction to right ventricular outflow have a less dynamic right ventricular impulse and may present with more of a tapping or thrusting quality.
Auscultation
- The classic presentation of pure mitral stenosis such as the loud first heart sound, opening snap, mid-diastolic rumble with presystolic accentuation are not usually heard.[1]
- A continuous murmur may be present in some cases of Lutembacher's syndrome with small ASD and a tight mitral stenosis because of the high left atrium-to-low right atrial pressure difference across the ASD, which persists during the entire cardiac cycle.[1]
- A loud pulmonic mid-systollic murmur and a holosystollic murmur due to the presence of a tricuspid regurgitation may also be present in these patients.[1]
References
- ↑ 1.0 1.1 1.2 Olivares-Reyes A, Al-Kamme A (2005). "Lutembacher's syndrome with small atrial septal defect diagnosed by transthoracic and transesophageal echocardiography that underwent mitral valve replacement". J Am Soc Echocardiogr. 18 (10): 1105. doi:10.1016/j.echo.2005.01.017. PMID 16198889.