Eisenmenger’s syndrome physical examination: Difference between revisions

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Latest revision as of 15:01, 20 January 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD [2]

Overview

The general examination of patients with Eisenmenger's syndrome may show cyanosis, dermal changes, clubbing, peripheral edema, and abdominal swelling. Cardiac examination may show A wave dominant jugular venous pulse, right ventricular heave, high-pitched early diastolic murmur of pulmonary insufficiency, right-sided S4, pulmonary ejection click, single palpable S₂, and loud P₂.

Physical Examination

The physical examination of patients with Eisenmenger's syndrome may show the following^[1]^[2]^[3]:

Appearance of the Patient

Patients with Eisenmenger's syndrome usually appear lethargic and cyanotic.

Vital Signs

Skin

Skin examination of patients with Eisenmenger's syndrome usually shows:

Plethora
Livedo reticularis
Profound acrocyanosis
Urate depositions
Ecchymosis
Ischemic skin ulcerations

HEENT

HEENT examination of patients with Eisenmenger's syndrome is usually normal.

Neck

Lungs

Pulmonary examination of patients with Eisenmenger's syndrome is usually normal.

Heart

Jugular venous pulse wave may be A wave dominant
Precordial palpation reveals a right ventricular heave
High-pitched early diastolic murmur of pulmonary insufficiency
Right-sided S4
Pulmonary ejection click
Single palpable S₂
Loud P₂

Abdomen

Hepatomegaly
Jaundice
Right upper abdominal quadrant tenderness

Back

Back examination of patients with Eisenmenger's syndrome is usually normal.

Genitourinary

Genitourinary examination of patients with Eisenmenger's syndrome is usually normal.

Neuromuscular

Neuromuscular examination of patients with Eisenmenger's syndrome is usually normal.

Extremities

Cyanosis
Clubbing
Peripheral edema

Nail clubbing of fingers in a patient with Eisenmenger's syndrome. Case courtsey of Ann McGrath [Public domain].^[4]

References

↑ Kaemmerer H, Mebus S, Schulze-Neick I, Eicken A, Trindade PT, Hager A; et al. (2010). "The adult patient with eisenmenger syndrome: a medical update after dana point part I: epidemiology, clinical aspects and diagnostic options". Curr Cardiol Rev. 6 (4): 343–55. doi:10.2174/157340310793566154. PMC 3083816. PMID 22043211.
↑ Iveta S (2009). "Eisenmenger syndrome--a unique form of pulmonary arterial hypertension". Bratisl Lek Listy. 110 (12): 757–64. PMID 20196469.
↑ Vongpatanasin W, Brickner ME, Hillis LD, Lange RA (1998). "The Eisenmenger syndrome in adults". Ann Intern Med. 128 (9): 745–55. doi:10.7326/0003-4819-128-9-199805010-00008. PMID 9556469.
↑ https://en.wikipedia.org/wiki/Eisenmenger%27s_syndrome#/media/File:ClubbingFingers1.jpg/

Template:WH Template:WS

[pmid22043211-1] Kaemmerer H, Mebus S, Schulze-Neick I, Eicken A, Trindade PT, Hager A; et al. (2010). "The adult patient with eisenmenger syndrome: a medical update after dana point part I: epidemiology, clinical aspects and diagnostic options". Curr Cardiol Rev. 6 (4): 343–55. doi:10.2174/157340310793566154. PMC 3083816. PMID 22043211.

[pmid201964692-2] Iveta S (2009). "Eisenmenger syndrome--a unique form of pulmonary arterial hypertension". Bratisl Lek Listy. 110 (12): 757–64. PMID 20196469.

[pmid9556469-3] Vongpatanasin W, Brickner ME, Hillis LD, Lange RA (1998). "The Eisenmenger syndrome in adults". Ann Intern Med. 128 (9): 745–55. doi:10.7326/0003-4819-128-9-199805010-00008. PMID 9556469.

[4] ttps://en.wikipedia.org/wiki/Eisenmenger%27s_syndrome#/media/File:ClubbingFingers1.jpg/

[1]

[2]

[3]

[4]

@@ Line 3: / Line 3: @@
 {{CMG}}; {{AE}}{{AIA}}
 ==Overview==
+The general examination of patients with Eisenmenger's syndrome may show [[cyanosis]], dermal changes, [[clubbing]], [[peripheral edema]], and abdominal swelling. Cardiac examination may show [[A wave]] dominant [[Jugular venous pressure|jugular venous pulse]], right ventricular [[heave]], high-pitched early diastolic [[Heart murmur|murmur]] of [[pulmonary insufficiency]], right-sided [[S4]], pulmonary ejection click, single palpable [[S2|S<sub>2</sub>]], and loud [[P2|P<sub>2</sub>]].
 ==Physical Examination==
+The physical examination of patients with [[Eisenmenger's syndrome]] may show the following<ref name="pmid22043211">{{cite journal| author=Kaemmerer H, Mebus S, Schulze-Neick I, Eicken A, Trindade PT, Hager A et al.| title=The adult patient with eisenmenger syndrome: a medical update after dana point part I: epidemiology, clinical aspects and diagnostic options. | journal=Curr Cardiol Rev | year= 2010 | volume= 6 | issue= 4 | pages= 343-55 | pmid=22043211 | doi=10.2174/157340310793566154 | pmc=3083816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22043211  }}</ref><ref name="pmid201964692">{{cite journal| author=Iveta S| title=Eisenmenger syndrome--a unique form of pulmonary arterial hypertension. | journal=Bratisl Lek Listy | year= 2009 | volume= 110 | issue= 12 | pages= 757-64 | pmid=20196469 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20196469  }}</ref><ref name="pmid9556469">{{cite journal| author=Vongpatanasin W, Brickner ME, Hillis LD, Lange RA| title=The Eisenmenger syndrome in adults. | journal=Ann Intern Med | year= 1998 | volume= 128 | issue= 9 | pages= 745-55 | pmid=9556469 | doi=10.7326/0003-4819-128-9-199805010-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9556469  }}</ref>:
 === Appearance of the Patient ===
-* Patients with Eisenmenger's syndrome usually appear [general appearance].
+* Patients with [[Eisenmenger's syndrome]] usually appear lethargic and cyanotic.
 === Vital Signs ===
-* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
+* [[Tachycardia]]
-* Tachypnea / bradypnea
+*[[Tachypnea]]
-* Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
+*[[Postural hypotension]]
-* High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 === Skin ===
-Skin examination of patients with Eisenmenger's syndrome usually shows
+Skin examination of patients with Eisenmenger's syndrome usually shows:
 *[[Plethora]]
@@ Line 29: / Line 30: @@
 === HEENT ===
-* HEENT examination of patients with Eisenmenger's syndrome is usually normal.
+* HEENT examination of patients with [[Eisenmenger's syndrome]] is usually normal.
 === Neck ===
 * [[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 [disease name] is usually normal.
+* Pulmonary examination of patients with [[Eisenmenger's syndrome]] is usually normal.
 ===Heart===
-* Jugular venous pressure may be raised with 'a' wave indicating increased right atrial pressure. A 'v' wave indicating development of tricuspid regurgitation may also be seen
-* Right ventricular heave and thrill
+* [[Jugular venous pressure|Jugular venous pulse]] wave may be [[A wave]] dominant
-* Murmurs of tricuspid and pulmonic regurgitation maybe audible.
+* Precordial palpation reveals a right ventricular [[heave]]
-* Loud P2
+* High-pitched early diastolic [[Heart murmur|murmur]] of [[pulmonary insufficiency]]
-* Ejection click
+* Right-sided [[S4]]
+* Pulmonary ejection click
+* Single palpable [[S2|S<sub>2</sub>]]
+* Loud [[P2|P<sub>2</sub>]]
 ===Abdomen===
 * [[Hepatomegaly]]
-* [[Ascites]]
+*[[Jaundice]]
+*Right upper abdominal quadrant [[tenderness]]
 === Back ===
-* Back examination of patients with Eisenmenger's syndrome is usually normal.
+* Back examination of patients with [[Eisenmenger's syndrome]] is usually normal.
 === Genitourinary ===
-* Genitourinary examination of patients with Eisenmenger's syndrome is usually normal.
+* Genitourinary examination of patients with [[Eisenmenger's syndrome]] is usually normal.
 === Neuromuscular ===
-* Neuromuscular examination of patients with Eisenmenger's syndrome is usually normal.
+* Neuromuscular examination of patients with [[Eisenmenger's syndrome]] is usually normal.
 ===Extremities===
@@ Line 69: / Line 73: @@
 * Peripheral [[edema]]
+[[File:ClubbingFingers1.jpg|center|thumb|Nail clubbing of fingers in a patient with Eisenmenger's syndrome. Case courtsey of Ann McGrath [Public domain].<ref>https://en.wikipedia.org/wiki/Eisenmenger%27s_syndrome#/media/File:ClubbingFingers1.jpg/</ref>]]
+<br />
 ==References==
 {{reflist|2}}