Diastolic dysfunction physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]

Overview

The back pressure created due to the stiff ventricle in a patient with diastolic dysfunction is responsible for the signs mentioned below. There would be jugular venous distension due to dysfunction of the right heart and pulmonary congestion due to left heart diastolic dysfunction.

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

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

Skin

• The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock
• Cyanosis is observed if severe hypoxemia is present
• Anasarca

Neck

• Jugular vein distention
• Central venous pressure > 16 cmH₂O

Lungs

• Pleural effusion with dullness to percussion at the bases
• Rales

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 heart disease causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated.

Abdomen

• Hepatojugular reflux
• Hepatomegaly
• Ascites

Extremities

• Bilateral ankle edema

Neurologic

• Confusion and altered mentation

Signs that represent 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. Commonly signs of both left and right sided failure are present.