Syncope physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with syncope usually appear normal. Physical examination of patients with syncope is usually remarkable for [[cardiac]] [[murmur]], [[orthostatic hypotension]], and altered level of consciousness.
[[Patients]] with syncope usually appear normal. Physical examination of [[patients]] with syncope is usually remarkable for [[cardiac]] [[murmur]], [[orthostatic hypotension]], and altered level of consciousness.
==Physical Examination==
==Physical Examination==
Patients with syncope usually appear normal.  
[[Patients]] with syncope usually appear normal.  


Physical examination of patients with syncope is usually remarkable for [[cardiac]] [[murmur]], [[orthostatic hypotension]], and altered level of consciousness.
Physical examination of [[patients]] with syncope is usually remarkable for [[cardiac]] [[murmur]], [[orthostatic hypotension]], and altered level of consciousness.<ref name="WielingThijs2009">{{cite journal|last1=Wieling|first1=W.|last2=Thijs|first2=R. D.|last3=van Dijk|first3=N.|last4=Wilde|first4=A. A. M.|last5=Benditt|first5=D. G.|last6=van Dijk|first6=J. G.|title=Symptoms and signs of syncope: a review of the link between physiology and clinical clues|journal=Brain|volume=132|issue=10|year=2009|pages=2630–2642|issn=0006-8950|doi=10.1093/brain/awp179}}</ref><ref name="Sutton2013">{{cite journal|last1=Sutton|first1=Richard|title=Clinical Classification of Syncope|journal=Progress in Cardiovascular Diseases|volume=55|issue=4|year=2013|pages=339–344|issn=00330620|doi=10.1016/j.pcad.2012.11.005}}</ref><ref name="van DijkWieling2013">{{cite journal|last1=van Dijk|first1=J. Gert|last2=Wieling|first2=Wouter|title=Pathophysiological Basis of Syncope and Neurological Conditions that Mimic Syncope|journal=Progress in Cardiovascular Diseases|volume=55|issue=4|year=2013|pages=345–356|issn=00330620|doi=10.1016/j.pcad.2012.10.016}}</ref>
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with Syncope usually appear normal.
*[[Patients]] with Syncope usually appear normal.


===Vital Signs===
===Vital Signs===
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse may be present in the case, [[structural heart disease]] is the underlying cause of syncope.
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse may be present in the case, [[structural heart disease]] is the underlying cause of syncope.
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse may be present in the case, [[conductive heart disease]] is the underlying cause of syncope.
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse may be present in the case, conductive heart problems are the underlying cause of syncope.
*[[Orthostatic hypotension]] may be present.
*[[Orthostatic hypotension]] may be present.


===Skin===
===Skin===
* Skin examination of patients with syncope is usually normal. However, it may be remarkable for:
[[Skin]] examination of [[patients]] with syncope is usually normal. However, it may be remarkable for:
*[[Cyanosis]]  
 
* [[Pallor]]
*[[Cyanosis]]
*[[Pallor]]


===HEENT===
===HEENT===
* HEENT examination of patients with syncope is usually normal.
* HEENT examination of [[patients]] with syncope is usually normal.
 
===Neck===
Neck examination of [[patients]] with syncope is usually normal. However, it may be remarkable for the following findings depending on the underlying cause of syncope:
 
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope.
*[[Hepatojugular reflux]]
 
===Lungs===
*[[Pulmonary]] examination of [[patients]] with syncope is usually normal.
 
===Heart===
[[Cardiovascular]] examination of [[patients]] with syncope is usually normal. However, if the underlying cause of the syncope is [[cardiovascular disease]], it may be remarkable for:<ref name="Sutton2013">{{cite journal|last1=Sutton|first1=Richard|title=Clinical Classification of Syncope|journal=Progress in Cardiovascular Diseases|volume=55|issue=4|year=2013|pages=339–344|issn=00330620|doi=10.1016/j.pcad.2012.11.005}}</ref>
 
*[[Heave]] / [[thrill]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A  [[heart murmur]] may be heard using the stethoscope.
 
===Abdomen===
*[[Abdominal]] examination of [[patients]] with syncope is usually normal.
 
===Genitourinary===
*[[Genitourinary]] examination of [[patients]] with syncope is usually normal.
 
===Neuromuscular===
Neuromuscular examination of [[patients]] with syncope is usually normal. However, focal neurologic signs may be present if cerebrovascular events were misdiagnosed for syncope. These findings may include:<ref name="van DijkWieling2013">{{cite journal|last1=van Dijk|first1=J. Gert|last2=Wieling|first2=Wouter|title=Pathophysiological Basis of Syncope and Neurological Conditions that Mimic Syncope|journal=Progress in Cardiovascular Diseases|volume=55|issue=4|year=2013|pages=345–356|issn=00330620|doi=10.1016/j.pcad.2012.10.016}}</ref>
*[[Altered mental status]]
* Hyperreflexia
* Positive (abnormal) [[Babinski's sign|Babinski]]
*[[Muscle rigidity]]
* Proximal/distal [[muscle weakness]] unilaterally/bilaterally
*Unilateral/bilateral upper/lower extremity weakness
*[[Dysdiadochokinesia]] (palm tapping test)
* Opisthotonus and myoclonic jerks
===Extremities===
Extremities examination of [[patients]] with syncope is usually normal. It may be remarkable for the following findings depending on the underlying cause:
 
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 16:29, 20 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Patients with syncope usually appear normal. Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.

Physical Examination

Patients with syncope usually appear normal.

Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.[1][2][3]

Appearance of the Patient

  • Patients with Syncope usually appear normal.

Vital Signs

  • Tachycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, structural heart disease is the underlying cause of syncope.
  • Bradycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, conductive heart problems are the underlying cause of syncope.
  • Orthostatic hypotension may be present.

Skin

Skin examination of patients with syncope is usually normal. However, it may be remarkable for:

HEENT

  • HEENT examination of patients with syncope is usually normal.

Neck

Neck examination of patients with syncope is usually normal. However, it may be remarkable for the following findings depending on the underlying cause of syncope:

Lungs

Heart

Cardiovascular examination of patients with syncope is usually normal. However, if the underlying cause of the syncope is cardiovascular disease, it may be remarkable for:[2]

Abdomen

Genitourinary

Neuromuscular

Neuromuscular examination of patients with syncope is usually normal. However, focal neurologic signs may be present if cerebrovascular events were misdiagnosed for syncope. These findings may include:[3]

Extremities

Extremities examination of patients with syncope is usually normal. It may be remarkable for the following findings depending on the underlying cause:

References

  1. ↑ Wieling, W.; Thijs, R. D.; van Dijk, N.; Wilde, A. A. M.; Benditt, D. G.; van Dijk, J. G. (2009). "Symptoms and signs of syncope: a review of the link between physiology and clinical clues". Brain. 132 (10): 2630–2642. doi:10.1093/brain/awp179. ISSN 0006-8950.
  2. ↑ 2.0 2.1 Sutton, Richard (2013). "Clinical Classification of Syncope". Progress in Cardiovascular Diseases. 55 (4): 339–344. doi:10.1016/j.pcad.2012.11.005. ISSN 0033-0620.
  3. ↑ 3.0 3.1 van Dijk, J. Gert; Wieling, Wouter (2013). "Pathophysiological Basis of Syncope and Neurological Conditions that Mimic Syncope". Progress in Cardiovascular Diseases. 55 (4): 345–356. doi:10.1016/j.pcad.2012.10.016. ISSN 0033-0620.
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