Third degree AV block physical examination: Difference between revisions
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*The patient may present with [[altered mental status]] because of hypoperfusion. Patient may be [[diaphoresis|diaphoretic]] and pale experiencing severe [[chest pain]] if the cause of complete heart block is [[myocardial infarction]].<ref name="pmid10447229" /><ref name="pmid19667425" /> | *The patient may present with [[altered mental status]] because of hypoperfusion. Patient may be [[diaphoresis|diaphoretic]] and pale experiencing severe [[chest pain]] if the cause of complete heart block is [[myocardial infarction]].<ref name="pmid10447229">{{cite journal |vauthors=Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H |title=The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik study |journal=J. Intern. Med. |volume=246 |issue=1 |pages=81–6 |date=July 1999 |pmid=10447229 |doi=10.1046/j.1365-2796.1999.00521.x |url=}}</ref><ref name="pmid19667425">{{cite journal |vauthors=Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H |title=[Third degree atrioventricular block.] |language=Icelandic |journal=Laeknabladid |volume=84 |issue=1 |pages=8–15 |date=January 1998 |pmid=19667425 |doi= |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
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*[[Bradycardia]] may be present. | *[[Bradycardia]] may be present. | ||
*[[Tachypnea]] may be present. | *[[Tachypnea]] may be present. | ||
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===Skin=== | |||
* Skin [[rash]] may be present if the cause of complete heart block is [[endocarditis]] or [[rheumatic fever]] or [[Lyme disease]]. | |||
===Neck=== | |||
*[[Cannon 'a' wave]]s may be seen often. | |||
* Elevated [[JVP]] may be seen if heart failure is present. | |||
===Lungs=== | |||
* Basilar [[rales]] may be heard. | |||
===Heart=== | |||
====Auscultation==== | |||
* S<sub>3</sub> gallop may be heard in the presence of [[heart failure]]. | |||
===Extremities=== | |||
*[[Pedal edema]] may be present. | |||
===Skin=== | ===Skin=== | ||
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The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill. | The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill. | ||
==Physical Examination== | ==Physical Examination== | ||
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==References== | ==References== | ||
Revision as of 12:19, 28 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Raviteja Guddeti, M.B.B.S. [3] ; Aditya Ganti M.B.B.S. [4]
Overview
The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill.
Physical Examination
Physical examination of patients with third degree AV block is usually normal.
OR
Physical examination of patients with third degree AV block is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of third degree AV block.
OR
The presence of [finding(s)] on physical examination is highly suggestive of third degree AV block.
Appearance of the Patient
- The patient may present with altered mental status because of hypoperfusion. Patient may be diaphoretic and pale experiencing severe chest pain if the cause of complete heart block is myocardial infarction.[1][2]
Vital Signs
- Bradycardia may be present.
- Tachypnea may be present.
Skin
- Skin rash may be present if the cause of complete heart block is endocarditis or rheumatic fever or Lyme disease.
Neck
- Cannon 'a' waves may be seen often.
- Elevated JVP may be seen if heart failure is present.
Lungs
- Basilar rales may be heard.
Heart
Auscultation
- S3 gallop may be heard in the presence of heart failure.
Extremities
- Pedal edema may be present.
Skin
- Skin examination of patients with third degree AV block is usually normal.
OR
-
Description (Adapted from Dermatology Atlas)
-
Description (Adapted from Dermatology Atlas)
HEENT
- HEENT examination of patients with third degree AV block is usually normal.
OR
- Abnormalities of the head/hair may include ___
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
- Exudate from the ear canal
- Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
- Inflamed nares / congested nares
- Purulent exudate from the nares
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with third degree AV block is usually normal.
OR
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients with third degree AV block is usually normal.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds OR distant breath sounds
- Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with third degree AV block is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with third degree AV block is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with third degree AV block is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with third degree AV block is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with third degree AV block is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with third degree AV block is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
Overview
The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill.
Physical Examination
References
- ↑ Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H (July 1999). "The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik study". J. Intern. Med. 246 (1): 81–6. doi:10.1046/j.1365-2796.1999.00521.x. PMID 10447229.
- ↑ Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H (January 1998). "[Third degree atrioventricular block.]". Laeknabladid (in Icelandic). 84 (1): 8–15. PMID 19667425.