Non-bacterial thrombotic endocarditis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Non-bacterial thrombotic endocarditis}} | {{Non-bacterial thrombotic endocarditis}} | ||
{{CMG}}; {{AE}}{{Aisha}} | {{CMG}}; {{AE}}{{Aisha}} | ||
==Overview== | ==Overview== | ||
Patients with | There are no specific physical exam findings for non-bacterial thrombotic endocarditis. Patients with NBTE may show signs of systemic thromboembolism, cardiac dysfunction, and underlying diseases. | ||
==Physical Examination== | ==Physical Examination== | ||
There are no specific findings for | There are no specific findings for non-bacterial thrombotic endocarditis. Patients with NBTE may show signs of systemic thromboembolism, cardiac dysfunction, and underlying diseases. | ||
===General appearance=== | ===General appearance=== | ||
*Patients with NBTE usually appear non-toxic. Patients may present with acute signs of cerebral or systemic | *Patients with NBTE usually appear non-toxic. Patients may present with acute signs of cerebral or systemic embolisms of signs or cardiac dysfunction. | ||
===Vital Signs=== | ===Vital Signs=== | ||
* | *Fever (if due to malignancy or complicated by secondary infectious endocarditis | ||
* | *Hypotension (if severe left ventricular dysfunction is present) | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
* | *Tachypnea | ||
* | *Orthopnea | ||
===Skin=== | ===Skin=== | ||
* | *Raynaud's phenomenon (incase of peripheral embolism) | ||
* | *Malar rash (in patients with SLE) | ||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with | * HEENT examination of patients with NBTE is usually normal. | ||
===Neck=== | ===Neck=== | ||
*[[Jugular venous distension]] may be noted secondary to | *[[Jugular venous distension]] may be noted secondary to heart failure due to valvular dysfunction | ||
*[[Lymphadenopathy]] (in the case of malignancy) | *[[Lymphadenopathy]] (in the case of malignancy) | ||
===Lungs=== | ===Lungs=== | ||
*lung fields may be dull on | *lung fields may be dull on percussion in the presence of secondary infection, or pleural effusion due to malignancy | ||
===Heart=== | ===Heart=== | ||
Left ventricular hypertrophy due to aortic or mitral valve disease can present as any of the following | Left ventricular hypertrophy due to aortic or mitral valve disease can present as any of the following: | ||
**Displacement of apex beat | |||
* Displacement of apex beat | **Enlarged and sustained apical impulse | ||
* Enlarged and sustained apical impulse | **S4 | ||
* S4 | **S2 (due to aortic root dilatation) | ||
* S2 (due to aortic root dilatation) | |||
===Abdomen=== | ===Abdomen=== | ||
| Line 65: | Line 53: | ||
*[[Clubbing]] may be seen in patients with malignancies | *[[Clubbing]] may be seen in patients with malignancies | ||
*[[Cyanosis]] due to peripheral embolism | *[[Cyanosis]] due to peripheral embolism | ||
* | *Pedal edema may be observed if heart failure is present | ||
* | *Polyarthralgia and arthritis may be observed | ||
{| class="wikitable" | {| class="wikitable" | ||
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!style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Physical examination finding}} | !style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Physical examination finding}} | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Left ventricular hypertrophy]] | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Left ventricular hypertrophy]]<ref>https://www.medscape.com/answers/241381-7641/what-are-signs-of-left-ventricular-hypertrophy-lvh-in-cardiac-exam-of-hypertension-high-blood-pressure</ref><ref name="pmid11499746">{{cite journal| author=Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M | display-authors=etal| title=Relationship of the electrocardiographic strain pattern to left ventricular structure and function in hypertensive patients: the LIFE study. Losartan Intervention For End point. | journal=J Am Coll Cardiol | year= 2001 | volume= 38 | issue= 2 | pages= 514-20 | pmid=11499746 | doi=10.1016/s0735-1097(01)01378-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11499746 }} </ref><ref name="pmid4227953">{{cite journal| author=Pinto IJ, Nanda NC, Biswas AK, Parulkar VG| title=Tall upright T waves in the precordial leads. | journal=Circulation | year= 1967 | volume= 36 | issue= 5 | pages= 708-16 | pmid=4227953 | doi=10.1161/01.cir.36.5.708 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4227953 }} </ref><ref name="pmid12392827">{{cite journal| author=Okin PM, Devereux RB, Fabsitz RR, Lee ET, Galloway JM, Howard BV | display-authors=etal| title=Quantitative assessment of electrocardiographic strain predicts increased left ventricular mass: the Strong Heart Study. | journal=J Am Coll Cardiol | year= 2002 | volume= 40 | issue= 8 | pages= 1395-400 | pmid=12392827 | doi=10.1016/s0735-1097(02)02171-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12392827 }} </ref><ref name="pmid25170097">{{cite journal| author=Shah AS, Chin CW, Vassiliou V, Cowell SJ, Doris M, Kwok TC | display-authors=etal| title=Left ventricular hypertrophy with strain and aortic stenosis. | journal=Circulation | year= 2014 | volume= 130 | issue= 18 | pages= 1607-16 | pmid=25170097 | doi=10.1161/CIRCULATIONAHA.114.011085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25170097 }} </ref><ref name="pmid11078306">{{cite journal| author=Mehta A, Jain AC, Mehta MC, Billie M| title=Usefulness of left atrial abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block. | journal=Am J Cardiol | year= 2000 | volume= 85 | issue= 3 | pages= 354-9 | pmid=11078306 | doi=10.1016/s0002-9149(99)00746-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11078306 }} </ref> | ||
|[[Left ventricular hypertrophy|LVH]] can [[Presenting symptom|present]] as any of the following: | |[[Left ventricular hypertrophy|LVH]] can [[Presenting symptom|present]] as any of the following: | ||
| Line 101: | Line 89: | ||
*[[Rales]] on [[lung examination]] | *[[Rales]] on [[lung examination]] | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Secondary infective endocarditis]] ([[IE]]) | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Secondary infective endocarditis]] ([[IE]])<ref>https://emedicine.medscape.com/article/216650-clinical</ref><ref name="pmid29238103">{{cite journal| author=Jingushi N, Iwata M, Terasawa T| title=Clinical features of patients with infective endocarditis presenting to the emergency department: a retrospective case series. | journal=Nagoya J Med Sci | year= 2017 | volume= 79 | issue= 4 | pages= 467-476 | pmid=29238103 | doi=10.18999/nagjms.79.4.467 | pmc=5719206 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29238103 }} </ref><ref name="pmid23574121">{{cite journal| author=Hoen B, Duval X| title=Clinical practice. Infective endocarditis. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 15 | pages= 1425-33 | pmid=23574121 | doi=10.1056/NEJMcp1206782 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23574121 }} </ref><ref name="pmid26341945">{{cite journal| author=Cahill TJ, Prendergast BD| title=Infective endocarditis. | journal=Lancet | year= 2016 | volume= 387 | issue= 10021 | pages= 882-93 | pmid=26341945 | doi=10.1016/S0140-6736(15)00067-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26341945 }} </ref> | ||
|[[Infective endocarditis|IE]] can [[Presenting symptom|present]] as: | |[[Infective endocarditis|IE]] can [[Presenting symptom|present]] as: | ||
| Line 136: | Line 124: | ||
*[[Back pain]] (due to [[vertebral osteomyelitis]]) | *[[Back pain]] (due to [[vertebral osteomyelitis]]) | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Mitral valve disease]] | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Mitral valve disease]]<ref name="HojnikGeorge1996">{{cite journal|last1=Hojnik|first1=Maja|last2=George|first2=Jacob|last3=Ziporen|first3=Lea|last4=Shoenfeld|first4=Yehuda|title=Heart Valve Involvement (Libman-Sacks Endocarditis) in the Antiphospholipid Syndrome|journal=Circulation|volume=93|issue=8|year=1996|pages=1579–1587|issn=0009-7322|doi=10.1161/01.CIR.93.8.1579}}</ref> | ||
| | | | ||
* High-[[Pitch|pitched]] “blowing” [[holosystolic murmur]] of '''[[mitral regurgitation]]''' (more common) which is best [[Hearing|heard]] at the [[apex of the heart]] with the [[patient]] in left [[lateral]] [[decubitus]] [[Position effect|position]]. | * High-[[Pitch|pitched]] “blowing” [[holosystolic murmur]] of '''[[mitral regurgitation]]''' (more common) which is best [[Hearing|heard]] at the [[apex of the heart]] with the [[patient]] in left [[lateral]] [[decubitus]] [[Position effect|position]]. | ||
| Line 159: | Line 147: | ||
{{WS}} | {{WS}} | ||
[[Category: (name of the system)]] | [[Category: (name of the system)]] | ||
Latest revision as of 21:51, 22 August 2020
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non-bacterial thrombotic endocarditis |
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Differentiating non-bacterial thrombotic endocarditis from other Diseases |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]
Overview
There are no specific physical exam findings for non-bacterial thrombotic endocarditis. Patients with NBTE may show signs of systemic thromboembolism, cardiac dysfunction, and underlying diseases.
Physical Examination
There are no specific findings for non-bacterial thrombotic endocarditis. Patients with NBTE may show signs of systemic thromboembolism, cardiac dysfunction, and underlying diseases.
General appearance
- Patients with NBTE usually appear non-toxic. Patients may present with acute signs of cerebral or systemic embolisms of signs or cardiac dysfunction.
Vital Signs
- Fever (if due to malignancy or complicated by secondary infectious endocarditis
- Hypotension (if severe left ventricular dysfunction is present)
- Tachycardia
- Tachypnea
- Orthopnea
Skin
- Raynaud's phenomenon (incase of peripheral embolism)
- Malar rash (in patients with SLE)
HEENT
- HEENT examination of patients with NBTE is usually normal.
Neck
- Jugular venous distension may be noted secondary to heart failure due to valvular dysfunction
- Lymphadenopathy (in the case of malignancy)
Lungs
- lung fields may be dull on percussion in the presence of secondary infection, or pleural effusion due to malignancy
Heart
Left ventricular hypertrophy due to aortic or mitral valve disease can present as any of the following:
- Displacement of apex beat
- Enlarged and sustained apical impulse
- S4
- S2 (due to aortic root dilatation)
Abdomen
- Abdominal distension
- Abdominal pain/tenderness in the left upper quadrant due to splenic embolism
- Flank pain
- Ascites may be observed in cases of heart failure and fluid overload
Genitourinary
- Genitourinary examination of patients with NBTE is usually normal
Extremities
- Clubbing may be seen in patients with malignancies
- Cyanosis due to peripheral embolism
- Pedal edema may be observed if heart failure is present
- Polyarthralgia and arthritis may be observed
References
- ↑ https://www.medscape.com/answers/241381-7641/what-are-signs-of-left-ventricular-hypertrophy-lvh-in-cardiac-exam-of-hypertension-high-blood-pressure
- ↑ Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M; et al. (2001). "Relationship of the electrocardiographic strain pattern to left ventricular structure and function in hypertensive patients: the LIFE study. Losartan Intervention For End point". J Am Coll Cardiol. 38 (2): 514–20. doi:10.1016/s0735-1097(01)01378-x. PMID 11499746.
- ↑ Pinto IJ, Nanda NC, Biswas AK, Parulkar VG (1967). "Tall upright T waves in the precordial leads". Circulation. 36 (5): 708–16. doi:10.1161/01.cir.36.5.708. PMID 4227953.
- ↑ Okin PM, Devereux RB, Fabsitz RR, Lee ET, Galloway JM, Howard BV; et al. (2002). "Quantitative assessment of electrocardiographic strain predicts increased left ventricular mass: the Strong Heart Study". J Am Coll Cardiol. 40 (8): 1395–400. doi:10.1016/s0735-1097(02)02171-x. PMID 12392827.
- ↑ Shah AS, Chin CW, Vassiliou V, Cowell SJ, Doris M, Kwok TC; et al. (2014). "Left ventricular hypertrophy with strain and aortic stenosis". Circulation. 130 (18): 1607–16. doi:10.1161/CIRCULATIONAHA.114.011085. PMID 25170097.
- ↑ Mehta A, Jain AC, Mehta MC, Billie M (2000). "Usefulness of left atrial abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block". Am J Cardiol. 85 (3): 354–9. doi:10.1016/s0002-9149(99)00746-8. PMID 11078306.
- ↑ https://emedicine.medscape.com/article/216650-clinical
- ↑ Jingushi N, Iwata M, Terasawa T (2017). "Clinical features of patients with infective endocarditis presenting to the emergency department: a retrospective case series". Nagoya J Med Sci. 79 (4): 467–476. doi:10.18999/nagjms.79.4.467. PMC 5719206. PMID 29238103.
- ↑ Hoen B, Duval X (2013). "Clinical practice. Infective endocarditis". N Engl J Med. 368 (15): 1425–33. doi:10.1056/NEJMcp1206782. PMID 23574121.
- ↑ Cahill TJ, Prendergast BD (2016). "Infective endocarditis". Lancet. 387 (10021): 882–93. doi:10.1016/S0140-6736(15)00067-7. PMID 26341945.
- ↑ Hojnik, Maja; George, Jacob; Ziporen, Lea; Shoenfeld, Yehuda (1996). "Heart Valve Involvement (Libman-Sacks Endocarditis) in the Antiphospholipid Syndrome". Circulation. 93 (8): 1579–1587. doi:10.1161/01.CIR.93.8.1579. ISSN 0009-7322.