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 1: / Line 1: @@
+__NOTOC__
+{{Template:Eisenmenger's syndrome}}
+{{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 lethargic and cyanotic.
+=== Vital Signs ===
+* [[Tachycardia]]
+*[[Tachypnea]]
+*[[Postural hypotension]]
+=== Skin ===
+Skin examination of patients with Eisenmenger's syndrome usually shows:
-{{Template:Eisenmenger's syndrome}}
+*[[Plethora]]
-{{CMG}}
+*[[Livedo reticularis]]
+*Profound [[acrocyanosis]]
+*[[Urate]] depositions
+*[[Ecchymosis]]
+*Ischemic skin [[ulcerations]]
+=== HEENT ===
+* HEENT examination of patients with [[Eisenmenger's syndrome]] is usually normal.
+=== Neck ===
+* [[Jugular venous distension]]
+* [[Hepatojugular reflux]]
+=== Lungs ===
+* Pulmonary examination of patients with [[Eisenmenger's syndrome]] is usually normal.
+===Heart===
-'''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamavada Singh, MBBS]] [[mailto:psingh@perfuse.org]]
+* [[Jugular venous pressure|Jugular venous pulse]] wave may be [[A wave]] dominant
+* Precordial palpation reveals a 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>]]
+* Loud [[P2|P<sub>2</sub>]]
-'''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
+===Abdomen===
+* [[Hepatomegaly]]
+*[[Jaundice]]
+*Right upper abdominal quadrant [[tenderness]]
-'''Physical examination'''
+=== Back ===
+* Back examination of patients with [[Eisenmenger's syndrome]] is usually normal.
-* Central cyanosis
+=== Genitourinary ===
-* Clubbing
-Signs of increased right atrial pressure
+* Genitourinary examination of patients with [[Eisenmenger's syndrome]] is usually normal.
-* 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
+=== Neuromuscular ===
-* Peripheral edema
-* Hepatomegaly
-* Ascites
-Cardiovascular examination
+* Neuromuscular examination of patients with [[Eisenmenger's syndrome]] is usually normal.
-* Right ventricular heave and thrill
+===Extremities===
-* Murmurs of tricuspid and pulmonic regurgitation maybe audible.
+* C[[cyanosis|yanosis]]
+* [[Clubbing]]
+* 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}}