Cardiac disease in pregnancy physical examination: Difference between revisions
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{{Cardiac disease in pregnancy}} | {{Cardiac disease in pregnancy}} | ||
{{CMG}}; {{AOEIC}} {{CZ}}; {{LG}} | {{CMG}}; {{AOEIC}} {{CZ}}; {{LG}} | ||
==Overview== | ==Overview== | ||
Normal physical exam signs of pregnancy include an "innocent" systolic flow murmur in 96% of patients due to the hyperdaynamic circulation, a diastolic murmur in 18% of patients, [[jugular venous distension]] and a displaced [[cardiac apex]] due to volume expansion, an S<sub>3</sub> in 84% of patients, an occasional S<sub>4</sub>, [[varicose veins]] and [[pedal edema]]. | |||
==Physical Examination== | |||
==Vitals== | ===Vitals=== | ||
*Arterial pulses are high volume and [[Collapsing pulse|collapsing in nature]]. Such [[collapsing pulse]] must be differentiated from other hyperdynamic states including [[aortic insufficiency]] and [[hyperthyroidism]]. | *Arterial pulses are high volume and [[Collapsing pulse|collapsing in nature]]. Such [[collapsing pulse]] must be differentiated from other hyperdynamic states including [[aortic insufficiency]] and [[hyperthyroidism]]. | ||
==Neck== | ===Neck=== | ||
*[[Jugular venous distension]] may be present | *The carotid upstroke is brisk due to the volume expansion and hyperdynamic state | ||
*[[Jugular venous distension]] may be present due to the volume expansion | |||
== | ===Heart=== | ||
====Heart Sounds:==== | ====Heart Sounds:==== | ||
*Increased intensity of the first [[heart sound]] secondary to physiologic hyperdynamic circulation during pregnancy | *Increased intensity of the first [[heart sound]] secondary to physiologic hyperdynamic circulation during pregnancy | ||
*An | *An S<sub>4</sub> is occasionally heard | ||
*An | *An S<sub>3</sub> is heard in 84% of cases | ||
====Murmur:==== | ====Murmur:==== | ||
*In general there are often innocent [[murmurs]] of pregnancy. These are the result of a hyperkinetic circulation. These murmurs are usually midsystolic and soft and heard best at the left lower sternal border and over the pulmonic area. | |||
*A systolic murmur is heard in 96% of patients, and a diastolic murmur is heard in 18% of patients. | |||
*Pulmonic [[Heart murmur#Systolic Murmurs|midsystolic murmur]] | *Pulmonic [[Heart murmur#Systolic Murmurs|midsystolic murmur]] | ||
*[[Continuous murmur]] (mammary soufflé, cervical hum) | *[[Continuous murmur]] ([[mammary soufflé]], [[cervical hum]]) | ||
* | ===Lungs=== | ||
*Adventitious sounds such as basal [[rales]] may be appreciated | |||
==Extremities== | ===Extremities=== | ||
*[[Varicosities]] and [[ankle edema]] secondary to [[IVC|inferior vena caval]] compression | *[[Varicosities]] and [[ankle edema]] secondary to [[IVC|inferior vena caval]] compression | ||
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{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[CME Category::Cardiology]] | |||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Obstetrics]] | |||
[[Category:Cardiology board review]] | |||
Latest revision as of 20:48, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]
Overview
Normal physical exam signs of pregnancy include an "innocent" systolic flow murmur in 96% of patients due to the hyperdaynamic circulation, a diastolic murmur in 18% of patients, jugular venous distension and a displaced cardiac apex due to volume expansion, an S3 in 84% of patients, an occasional S4, varicose veins and pedal edema.
Physical Examination
Vitals
- Arterial pulses are high volume and collapsing in nature. Such collapsing pulse must be differentiated from other hyperdynamic states including aortic insufficiency and hyperthyroidism.
Neck
- The carotid upstroke is brisk due to the volume expansion and hyperdynamic state
- Jugular venous distension may be present due to the volume expansion
Heart
Heart Sounds:
- Increased intensity of the first heart sound secondary to physiologic hyperdynamic circulation during pregnancy
- An S4 is occasionally heard
- An S3 is heard in 84% of cases
Murmur:
- In general there are often innocent murmurs of pregnancy. These are the result of a hyperkinetic circulation. These murmurs are usually midsystolic and soft and heard best at the left lower sternal border and over the pulmonic area.
- A systolic murmur is heard in 96% of patients, and a diastolic murmur is heard in 18% of patients.
- Pulmonic midsystolic murmur
- Continuous murmur (mammary soufflé, cervical hum)
Lungs
- Adventitious sounds such as basal rales may be appreciated
Extremities
- Varicosities and ankle edema secondary to inferior vena caval compression