Diastolic dysfunction physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
In general, signs of both [[left sided heart failure]] and [[right sided heart failure]] are present. | In general, signs of both [[left sided heart failure]] and [[right sided heart failure]] are present. Signs that represent acute left sided failure include cool clammy skin, [[cyanosis]], [[rales]] and a [[gallop rhythm]]. Signs that represent right sided failure include an elevated [[JVP]], [[pedal edema]], [[ascites]], [[hepatomegaly]], a [[parasternal heave]] and [[hepatojugular reflux]]. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
* The patient is often sitting upright and there may be labored breathing during an acute episode | * The patient is often sitting upright and there may be labored breathing during an acute episode | ||
* The patient's weight should be recorded to ascertain how far they are from their "dry" weight | * The patient's weight should be recorded to ascertain how far they are from their "dry" weight | ||
===Vitals=== | ===Vitals=== | ||
====Pulse==== | ====Pulse==== | ||
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====Blood Pressure==== | ====Blood Pressure==== | ||
*A [[narrow pulse pressure]] (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present | *A [[narrow pulse pressure]] (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present | ||
====Respiratory Rate==== | ====Respiratory Rate==== | ||
* [[Tachypnea]] (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure | * [[Tachypnea]] (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure | ||
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===Lungs=== | ===Lungs=== | ||
* [[Pleural effusion]] with dullness to percussion at the bases | * [[Pleural effusion]] with dullness to percussion at the bases may be present in both acute and chronic heart failure | ||
* [[Rales]] | * [[Rales]] is often present in both acute and chronic heart failure | ||
===Heart=== | ===Heart=== | ||
* If the right ventricular pressure is increased, a [[parasternal heave]] may be present, signifying the compensatory increase in contraction strength. | * If the right ventricular pressure is increased, a [[parasternal heave]] may be present, signifying the compensatory increase in contraction strength. | ||
====Auscultation==== | ====Auscultation==== | ||
* [[S3]] and a [[gallop rhythm]] | * [[S3]] and a [[gallop rhythm]] | ||
* Underlying [[valvular | * Underlying [[valvular]] causes of diastolic heart failure such as [[mitral stenosis]], and [[aortic stenosis]] may be auscultated | ||
===Abdomen=== | ===Abdomen=== | ||
* [[Hepatojugular reflux]] | * [[Hepatojugular reflux]] | ||
* [[Hepatomegaly]] | * [[Hepatomegaly]] may be present as a result of chronic heart failure | ||
* [[Ascites]] | * [[Ascites]] may be present as a result of chronic heart failure | ||
===Extremities=== | ===Extremities=== | ||
* [[ankle edema|Bilateral ankle edema]] | * [[ankle edema|Bilateral ankle edema]] may be present as a result of chronic heart failure | ||
===Neurologic=== | ===Neurologic=== | ||
* [[Confusion]] and altered mentation | * [[Confusion]] and altered mentation may be present in the setting of acute heart failure | ||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Categor:Best pages]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 12:07, 30 January 2013
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Diastolic dysfunction Microchapters |
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Diastolic dysfunction physical examination On the Web |
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American Roentgen Ray Society Images of Diastolic dysfunction physical examination |
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Risk calculators and risk factors for Diastolic dysfunction physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]
Overview
In general, signs of both left sided heart failure and right sided heart failure are present. Signs that represent acute left sided failure include cool clammy skin, cyanosis, rales and a gallop rhythm. Signs that represent right sided failure include an elevated JVP, pedal edema, ascites, hepatomegaly, a parasternal heave and hepatojugular reflux.
Physical Examination
Appearance of the Patient
- The patient is often sitting upright and there may be labored breathing during an acute episode
- The patient's weight should be recorded to ascertain how far they are from their "dry" weight
Vitals
Pulse
Rate
- Tachycardia may be present during an episode of acute heart failure
Blood Pressure
- A narrow pulse pressure (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present
Respiratory Rate
- Tachypnea (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure
Skin
- The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock may be present during an episode of acute heart failure
- Cyanosis is observed if severe hypoxemia is present during an episode of acute heart failure
- Anasarca may be present due to chronic heart failure
Neck
- Jugular vein distention is often present in both acute and chronic heart failure
- Central venous pressure > 16 cmH2O is often present in both acute and chronic heart failure
Lungs
- Pleural effusion with dullness to percussion at the bases may be present in both acute and chronic heart failure
- Rales is often present in both acute and chronic heart failure
Heart
- If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.
Auscultation
- S3 and a gallop rhythm
- Underlying valvular causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated
Abdomen
- Hepatojugular reflux
- Hepatomegaly may be present as a result of chronic heart failure
- Ascites may be present as a result of chronic heart failure
Extremities
- Bilateral ankle edema may be present as a result of chronic heart failure
Neurologic
- Confusion and altered mentation may be present in the setting of acute heart failure