Ebsteins anomaly of the tricuspid valve physical examination: Difference between revisions
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{{Template:Ebstein's anomaly of the tricuspid valve}} | {{Template:Ebstein's anomaly of the tricuspid valve}} | ||
{{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu] | {{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu] | ||
'''Associate Editor-In-Chief:''' {{CZ}}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu] [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]] | '''Associate Editor-In-Chief:''' {{CZ}}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu] [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]] '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]] | ||
==Overview== | |||
==Physical Examination== | |||
===Appearance=== | |||
=== | |||
Patients may have a bluish coloration of their face depending on the degree of [[cyanosis]] and right to left shunting. | Patients may have a bluish coloration of their face depending on the degree of [[cyanosis]] and right to left shunting. | ||
== Heart == | ===Heart === | ||
'''Inspection''' | '''Inspection''' | ||
* Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen. | * Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen. | ||
* The chest may be asymmetric due to an enlarged right heart. | * The chest may be asymmetric due to an enlarged right heart. | ||
* Apical impulses could be appreciated | * Apical impulses could be appreciated | ||
* Elevated jugular venous distension | |||
'''Palpation''' | '''Palpation''' | ||
* Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure. | * Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure. | ||
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* Prominent S3 and S4 may be appreciated (multiple heart sound). | * Prominent S3 and S4 may be appreciated (multiple heart sound). | ||
* Holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border and increases with inspiration. | * Holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border and increases with inspiration. | ||
* Mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve | * Mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve | ||
===Extremities=== | |||
* [[Clubbing]] | |||
* [[Cyanosis]] | |||
==References== | ==References== | ||
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{{Congenital malformations and deformations of circulatory system}} | {{Congenital malformations and deformations of circulatory system}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 19:09, 2 October 2012
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Ebsteins anomaly of the tricuspid valve Microchapters | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]}; Keri Shafer, M.D. [4] Priyamvada Singh, MBBS [[5]] Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]
Overview
Physical Examination
Appearance
Patients may have a bluish coloration of their face depending on the degree of cyanosis and right to left shunting.
Heart
Inspection
- Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen.
- The chest may be asymmetric due to an enlarged right heart.
- Apical impulses could be appreciated
- Elevated jugular venous distension
Palpation
- Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure.
- Palpable prominent diffuse apical impulse
- Systolic thrill at the left lower sternal border
Auscultation
- Widely split first and second heart sounds, due to right bundle branch block seen with this condition.
- Prominent S3 and S4 may be appreciated (multiple heart sound).
- Holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border and increases with inspiration.
- Mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve