Congenital heart disease physical examination: Difference between revisions
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{{Congenital heart disease}} | {{Congenital heart disease}} | ||
{{CMG}} {{AE}} {{KD}} | |||
==Overview== | |||
==Physical Examination== | |||
===Vitals=== | |||
====Pulse==== | |||
* [[Tachycardia]] may be present | |||
====Respiratory Rate==== | |||
* [[Tachypnea]] may be present | |||
===Chest=== | |||
* [[Wheezing]] may be present | |||
===Heart=== | |||
'''Inspection''' | |||
* Precordial bulge may be present | |||
'''Palpation''' | |||
* [[Thrill]] due to outflow tract obstruction or a restrictive ventricular septal defect | |||
* Increased apical activity suggestive of left ventricular volume or pressure overload | |||
'''Auscultation''' | |||
* A single second heart sound occurs in the following conditions: | |||
** Aortic atresia | |||
** [[Pulmonary atresia]] | |||
** [[Truncus arteriosus]] | |||
** Conditions with [[pulmonary hypertension]] | |||
* Widely or fixed split S2 occurs with [[atrial septal defect]] | |||
* Early systolic clicks, which occur with [[semilunar valve stenosis]], [[bicuspid aortic valve]], and [[Persistent truncus arteriosus|truncus arteriosus]]. | |||
* Mid-systolic clicks, which are heard with [[mitral valve prolapse]] and with [[Ebstein's anomaly of the tricuspid valve]]. | |||
* An S3 gallop, which, in infants, can result from ventricular dysfunction | |||
* Murmurs | |||
** [[Atrial septal defect]]: Systolic murmur heard best at the left upper sternal border | |||
** [[Ventricular septal defect]]: Holosytolic murmur heard best at the left upper sternal border | |||
** [[Patent ductus arteriosus]]: Machinery murmur heard best in the left infraclavicular region | |||
** [[Tetralogy of fallot]]: A harsh systolic ejection murmur best heard at the left sternal border is usually present. | |||
** [[Persistent truncus arteriosus]]: Systole ejection murmur is heard at the left sternal border | |||
** [[Transposition of the great vessels]]: The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery. Systolic murmurs are absent '''in neonates''' unless a subpulmonic stenosis is present | |||
** [[Total anomalous pulmonary venous connection]]: Systolic ejection [[murmur]] is heard at left upper sternal border. Diastolic murmur due to tricuspid regurgitation is also heard. | |||
===Abdomen=== | |||
* [[Hepatomegaly]] often occurs in patient with [[congestive heart failure]]. | |||
===Extremities=== | |||
* [[Cyanosis]] | |||
* [[Clubbing]] | |||
* Skeletal abnormalities, especially those of the hand and arm, are often associated with cardiac malformations. | |||
==References== | ==References== | ||
Revision as of 16:40, 19 October 2012
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Congenital heart disease Microchapters |
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Differentiating Congenital heart disease from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Congenital heart disease physical examination On the Web |
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American Roentgen Ray Society Images of Congenital heart disease physical examination |
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Risk calculators and risk factors for Congenital heart disease physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Physical Examination
Vitals
Pulse
- Tachycardia may be present
Respiratory Rate
- Tachypnea may be present
Chest
- Wheezing may be present
Heart
Inspection
- Precordial bulge may be present
Palpation
- Thrill due to outflow tract obstruction or a restrictive ventricular septal defect
- Increased apical activity suggestive of left ventricular volume or pressure overload
Auscultation
- A single second heart sound occurs in the following conditions:
- Aortic atresia
- Pulmonary atresia
- Truncus arteriosus
- Conditions with pulmonary hypertension
- Widely or fixed split S2 occurs with atrial septal defect
- Early systolic clicks, which occur with semilunar valve stenosis, bicuspid aortic valve, and truncus arteriosus.
- Mid-systolic clicks, which are heard with mitral valve prolapse and with Ebstein's anomaly of the tricuspid valve.
- An S3 gallop, which, in infants, can result from ventricular dysfunction
- Murmurs
- Atrial septal defect: Systolic murmur heard best at the left upper sternal border
- Ventricular septal defect: Holosytolic murmur heard best at the left upper sternal border
- Patent ductus arteriosus: Machinery murmur heard best in the left infraclavicular region
- Tetralogy of fallot: A harsh systolic ejection murmur best heard at the left sternal border is usually present.
- Persistent truncus arteriosus: Systole ejection murmur is heard at the left sternal border
- Transposition of the great vessels: The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery. Systolic murmurs are absent in neonates unless a subpulmonic stenosis is present
- Total anomalous pulmonary venous connection: Systolic ejection murmur is heard at left upper sternal border. Diastolic murmur due to tricuspid regurgitation is also heard.
Abdomen
- Hepatomegaly often occurs in patient with congestive heart failure.
Extremities
- Skeletal abnormalities, especially those of the hand and arm, are often associated with cardiac malformations.