Third degree AV block physical examination: Difference between revisions
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* Basilar [[rales]] may be heard. | * Basilar [[rales]] may be heard. | ||
* | * | ||
===Heart=== | ===Heart=== | ||
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===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with third degree AV block is usually normal. | * Abdominal examination of patients with third degree AV block is usually normal. | ||
* | *Nevertheless it depends to the basic etiology, for example in other rare etiologies of complete heart block such as infectious- rheumatologic / granolomatosis disease or amyloid disease the following findings might be present: | ||
*[[Hepatomegaly]] | |||
*[[Splenomegaly]] | |||
*H[[hepatosplenomegaly|epatosplenomegaly]] | |||
*[[Hepatomegaly]] | |||
===Back=== | ===Back=== | ||
* Back examination of patients with third degree AV block is usually normal. | * Back examination of patients with third degree AV block is usually normal. | ||
*Sacral edema ight be present in heart failure | |||
*Sacral edema | |||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with third degree AV block is usually normal. | * Genitourinary examination of patients with third degree AV block is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with third degree AV block is usually normal. | * Neuromuscular examination of patients with third degree AV block is usually normal. | ||
* | *In rare etiologies of complete heart block such as infectious, rheumatologic, granolomatosis disease or amyloid disease abnormal findings might be present such as: | ||
* Altered mental status | * Altered mental status | ||
* Glasgow coma scale is ___ / 15 | * Glasgow coma scale is ___ / 15 | ||
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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 remarkable for bradycardia, hypotension and hypoperfusion plus/minus sign and symptoms of heart failure such as edema, pulmonary rales, and S3 gollop. In the presence of primary etiology and secondary heart block such as myocardial infarction or Lyme disease other sign and symptoms such as rash or chest pain might be present as well.
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.
- Patients might be febrile (Lyme disease, endocarditis)
Skin
- Skin rash may be present if the cause of complete heart block is endocarditis or rheumatic fever or Lyme disease.
HEENT
- HEENT examination of patients with third degree AV block is usually normal.
- Cyanosis might be present.
- In the case of Lyme disease:
- Headache
- Pain on neck flexion
- Some patients may have:
- Pharyngitis
- Conjunctivitis
- Ptosis
- Facial nerve palsy
Neck
- Cannon 'a' waves may be seen often.
- Elevated JVP may be seen in the presence of heart failure.
Lungs
- Basilar rales may be heard.
Heart
- S3 gallop may be heard in the presence of heart failure.
Abdomen
- Abdominal examination of patients with third degree AV block is usually normal.
- Nevertheless it depends to the basic etiology, for example in other rare etiologies of complete heart block such as infectious- rheumatologic / granolomatosis disease or amyloid disease the following findings might be present:
- Hepatomegaly
- Splenomegaly
- Hepatosplenomegaly
Back
- Back examination of patients with third degree AV block is usually normal.
- Sacral edema ight be present in heart failure
Genitourinary
- Genitourinary examination of patients with third degree AV block is usually normal.
Neuromuscular
- Neuromuscular examination of patients with third degree AV block is usually normal.
- In rare etiologies of complete heart block such as infectious, rheumatologic, granolomatosis disease or amyloid disease abnormal findings might be present such as:
- 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
- Pedal edema may be present.
- 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
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.