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==Overview==
==Overview==
Physical examination of patients with Brugada syndrome is usually normal. Insofar as Brugada syndrome is not associated with any structural heart disease, there are generally no abnormalities on physical examination.  [[Vagal maneuvers]] such as [[carotid sinus massage]] may increase vagal tone and may unmask the presence of a Type I Brugada pattern. <ref name="CrossonHanash2010">{{cite journal|last1=Crosson|first1=JaneE|last2=Hanash|first2=CarlaR|title=Emergency diagnosis and management of pediatric arrhythmias|journal=Journal of Emergencies, Trauma, and Shock|volume=3|issue=3|year=2010|pages=251|issn=0974-2700|doi=10.4103/0974-2700.66525}}</ref> In a patient who has experienced recent symptoms such as syncope, it is important to check the temperature in so far as fever may trigger a self terminating or sustained episode of [[ventricular tachycardia]] / [[ventricular fibrillation]]. The presence of fever is also a target of antipyretic therapy.
[[Patients]] with Brugada syndrome usually appear usually normal. [[Physical examination]] of [[patients]] with Brugada syndrome is usually remarkable by [[vagal maneuvers]] such as [[carotid sinus massage]] may increase [[vagal]] tone and may unmask the presence of a Type I Brugada pattern.  
==Overview==
Patients with Brugada syndrome usually appear usually normal. Physical examination of patients with Brugada syndrome is usually remarkable by [[vagal maneuvers]] such as [[carotid sinus massage]] may increase vagal tone and may unmask the presence of a Type I Brugada pattern.  


The presence of recent symptoms such as syncope, it is important to check the temperature in so far as fever may trigger a self terminating or sustained episode of [[ventricular tachycardia]] / [[ventricular fibrillation]]. The presence of fever is also a target of antipyretic therapy on physical examination is highly suggestive of Brugada syndrome.
The presence of recent [[symptoms]] such as [[syncope]], it is important to check the temperature in so far as [[fever]] may trigger a self terminating or sustained episode of [[ventricular tachycardia]] / [[ventricular fibrillation]]. The presence of [[fever]] is also a target of [[Antipyretic|antipyretic therap]]<nowiki/>y on [[physical examination]] is highly suggestive of Brugada syndrome.


==Physical Examination==
==Physical Examination==
Physical examination of patients with Brugada syndrome is usually normal.


OR
*[[Patients]] with Brugada syndrome usually appear usually normal. [[Physical examination]] of [[patients]] with Brugada syndrome is usually remarkable by [[vagal maneuvers]] such as [[carotid sinus massage]] may increase [[vagal]] tone and may unmask the presence of a Type I Brugada pattern.<ref name="CrossonHanash20102">{{cite journal|last1=Crosson|first1=JaneE|last2=Hanash|first2=CarlaR|title=Emergency diagnosis and management of pediatric arrhythmias|journal=Journal of Emergencies, Trauma, and Shock|volume=3|issue=3|year=2010|pages=251|issn=0974-2700|doi=10.4103/0974-2700.66525}}</ref>


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*<nowiki/>The presence of recent [[symptoms]] such as [[syncope]], it is important to check the temperature in so far as [[fever]] may trigger a self terminating or sustained episode of [[ventricular tachycardia]] / [[ventricular fibrillation]]. The presence of [[fever]] is also a target of [[Antipyretic|antipyretic therap]]<nowiki/>y on [[physical examination]] is highly suggestive of Brugada syndrome.<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>


OR
=== Heart ===


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*[[Cardiovascular]] [[Physical examination|examination]] is required to rule out other possible [[Sudden cardiac death|cardiac]] causes of [[syncope]].<ref name="Arnar2013">{{cite journal|last1=Arnar|first1=David O.|title=Syncope in patients with structural heart disease|journal=Journal of Internal Medicine|volume=273|issue=4|year=2013|pages=336–344|issn=09546820|doi=10.1111/joim.12027}}</ref>
**[[Heart murmur|Heart murmurs]] from [[Hypertrophy (medical)|hypertrophic]] [[cardiomyopathy]]
**[[Valvular heart disease|Valvular]] or [[septal defect]]


OR


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
===Vital Signs===
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
<gallery widths="150px">
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
</gallery>
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[CME Category::Cardiology]]
[[CME Category::Cardiology|CME Category::]]<nowiki/>[[CME Category::Cardiology|Cardiology]]


[[Category:Needs content]]
[[Category:Needs content]]

Latest revision as of 16:32, 13 January 2020

Brugada syndrome Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

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Overview

Patients with Brugada syndrome usually appear usually normal. Physical examination of patients with Brugada syndrome is usually remarkable by vagal maneuvers such as carotid sinus massage may increase vagal tone and may unmask the presence of a Type I Brugada pattern.

The presence of recent symptoms such as syncope, it is important to check the temperature in so far as fever may trigger a self terminating or sustained episode of ventricular tachycardia / ventricular fibrillation. The presence of fever is also a target of antipyretic therapy on physical examination is highly suggestive of Brugada syndrome.

Physical Examination

Heart


References

  1. Crosson, JaneE; Hanash, CarlaR (2010). "Emergency diagnosis and management of pediatric arrhythmias". Journal of Emergencies, Trauma, and Shock. 3 (3): 251. doi:10.4103/0974-2700.66525. ISSN 0974-2700.
  2. Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
  3. Arnar, David O. (2013). "Syncope in patients with structural heart disease". Journal of Internal Medicine. 273 (4): 336–344. doi:10.1111/joim.12027. ISSN 0954-6820.

Template:WH Template:WS CME Category::Cardiology