Transposition of the great vessels physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
In many cases, TGV is accompanied by other heart defects, the most common type being intracardiac shunts such as [[atrial septal defect]] (ASD) | In many cases, TGV is accompanied by other heart defects, the most common type being intracardiac shunts such as [[atrial septal defect]] (ASD), [[patent foramen ovale]] (PFO), [[ventricular septal defect]] (VSD), and [[patent ductus arteriosus]] (PDA). Stenosis, or other defects, of valves and/or vessels may also be present. | ||
==Physical Examination == | ==Physical Examination == |
Revision as of 17:14, 24 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]
Overview
In many cases, TGV is accompanied by other heart defects, the most common type being intracardiac shunts such as atrial septal defect (ASD), patent foramen ovale (PFO), ventricular septal defect (VSD), and patent ductus arteriosus (PDA). Stenosis, or other defects, of valves and/or vessels may also be present.
Physical Examination
Vitals
Respiratory Rate
- Tachypnea may be present
Heart
Palpation
- There is a prominent impulse at the lower left sternal border (the RV which is actually the morphologic LV).
Auscultation
Heart Sounds
- The first heart sound (S1) is normal in intensity because ventricular contraction is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
Murmurs
- The murmur of a large PDA in d-TGA, is usually systolic, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
- If d-TGA is accompanied by both a VSD and pulmonary stenosis, a systolic murmur will be present. Systolic murmurs are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistance is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is reduced by the anterior aorta.
- A VSD murmur (holosystolic) is absent at birth, until the pulmonary vascular resistance decreases. A subsequent increase in pulmonary resistance shortens and later abolishes the murmur.
Extremities
- Symmetric cyanosis is the main characteristic in physical appearance of patients with d-TGA, inadequate mixing, and low pulmonary arterial blood flow. Delayed mild cyanosis, and the appearance of congestive heart failure accompanies non-restrictive VSD.
- Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and large patent ductus arteriosus that has developed early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this point in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distributed to the lower extremities.