Ventricular tachycardia physical examination: Difference between revisions
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{{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com] | {{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com] | ||
==Overview== | ==Overview== | ||
[[Physical examination]] should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. | [[Physical examination]] should consist of a thorough [[cardiac]] exam, [[lung]] exam, and close monitoring of [[vital]] signs. Findings on physical exam may include [[hemodynamic instablity]], [[cannon]] a wave in [[jugular venous pulsation]], [[ rales]] in [[lung fields]], lower limbs [[edema]], evidence of [[sternotomy]] scar due to previous [[ CABG]], and [[ICD]] pocket. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical findings depend in part on the [[P wave|P]]-to-[[QRS complex|QRS]] relationship with/without signs of [[AV dissociation]].<ref name="pmid3993009">{{cite journal |vauthors=Morady F, Shen EN, Bhandari A, Schwartz AB, Scheinman MM |title=Clinical symptoms in patients with sustained ventricular tachycardia |journal=West. J. Med. |volume=142 |issue=3 |pages=341–4 |date=March 1985 |pmid=3993009 |pmc=1306023 |doi= |url=}}</ref> | Physical findings depend in part on the [[P wave|P]]-to-[[QRS complex|QRS]] relationship with/without signs of [[AV dissociation]].<ref name="pmid3993009">{{cite journal |vauthors=Morady F, Shen EN, Bhandari A, Schwartz AB, Scheinman MM |title=Clinical symptoms in patients with sustained ventricular tachycardia |journal=West. J. Med. |volume=142 |issue=3 |pages=341–4 |date=March 1985 |pmid=3993009 |pmc=1306023 |doi= |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
* | * [[Carotid sinus massage]] may slow the [[atrial]] rate and, in some cases, expose [[AV dissociation]]. | ||
====Blood Pressure==== | ====[[Blood Pressure]]==== | ||
*[[Hemodynamic | *[[Hemodynamic compromised]] ([[hypotension]], [[shock]]) are often, but not always present. | ||
* Highly inconsistent fluctuations in the [[blood pressure]] can occur because of the variability in the degree of [[left atrium|left atrial]] (LA) contribution to LV filling, [[stroke volume]], and [[cardiac output]]. | * Highly inconsistent fluctuations in the [[blood pressure]] can occur because of the variability in the degree of [[left atrium|left atrial]] (LA) contribution to LV filling, [[stroke volume]], and [[cardiac output]]. | ||
===Neck=== | |||
* Intermittent [[cannon A waves]] can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction. | ===[[Neck]]=== | ||
===Heart=== | * Intermittent [[cannon A waves]] can be observed on examination of the [[jugular]] pulsation in the neck, and they reflect simultaneous [[atrial]] and [[ventricular]] contraction. | ||
===[[Heart]]=== | |||
* Variability in the occurrence and intensity of [[heart sounds]] (especially [[S1]]) may also be observed and is heard more frequently when the rate of the [[tachycardia]] is slower. | * Variability in the occurrence and intensity of [[heart sounds]] (especially [[S1]]) may also be observed and is heard more frequently when the rate of the [[tachycardia]] is slower. | ||
* Look for evidence of preexisting conditions like a [[pacemaker]]/[[AICD]] or [[scar]] mark from previous cardiothoracic surgery. | * Look for evidence of preexisting conditions like a [[pacemaker]]/[[AICD]] or [[scar]] mark from previous [[cardiothoracic surgery]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 04:42, 30 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Ventricular tachycardia physical examination On the Web |
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to Hospitals Treating Ventricular tachycardia physical examination |
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Risk calculators and risk factors for Ventricular tachycardia physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]
Overview
Physical examination should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. Findings on physical exam may include hemodynamic instablity, cannon a wave in jugular venous pulsation, rales in lung fields, lower limbs edema, evidence of sternotomy scar due to previous CABG, and ICD pocket.
Physical Examination
Physical findings depend in part on the P-to-QRS relationship with/without signs of AV dissociation.[1]
Vital Signs
- Carotid sinus massage may slow the atrial rate and, in some cases, expose AV dissociation.
Blood Pressure
- Hemodynamic compromised (hypotension, shock) are often, but not always present.
- Highly inconsistent fluctuations in the blood pressure can occur because of the variability in the degree of left atrial (LA) contribution to LV filling, stroke volume, and cardiac output.
Neck
- Intermittent cannon A waves can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction.
Heart
- Variability in the occurrence and intensity of heart sounds (especially S1) may also be observed and is heard more frequently when the rate of the tachycardia is slower.
- Look for evidence of preexisting conditions like a pacemaker/AICD or scar mark from previous cardiothoracic surgery.