Ventricular tachycardia physical examination: Difference between revisions
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Physical findings depend in part on the [[P wave|P]]-to-[[QRS complex|QRS]] relationship with/without signs of [[AV dissociation]].<ref name="pmid3993009">{{cite journal |vauthors=Morady F, Shen EN, Bhandari A, Schwartz AB, Scheinman MM |title=Clinical symptoms in patients with sustained ventricular tachycardia |journal=West. J. Med. |volume=142 |issue=3 |pages=341–4 |date=March 1985 |pmid=3993009 |pmc=1306023 |doi= |url=}}</ref> | Physical findings depend in part on the [[P wave|P]]-to-[[QRS complex|QRS]] relationship with/without signs of [[AV dissociation]].<ref name="pmid3993009">{{cite journal |vauthors=Morady F, Shen EN, Bhandari A, Schwartz AB, Scheinman MM |title=Clinical symptoms in patients with sustained ventricular tachycardia |journal=West. J. Med. |volume=142 |issue=3 |pages=341–4 |date=March 1985 |pmid=3993009 |pmc=1306023 |doi= |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
* Vitals are generally unaffected by [[carotid sinus massage]], although this maneuver may slow the atrial rate and, in some cases, expose [[AV dissociation]]. | * Vitals are generally unaffected by [[carotid sinus massage]], although this maneuver may slow the atrial rate and, in some cases, expose [[AV dissociation]]. | ||
====Blood Pressure==== | ====Blood Pressure==== | ||
*[[Hemodynamic compromise]] ([[hypotension]], [[shock]]) are often, but not always present. | *[[Hemodynamic compromise]] ([[hypotension]], [[shock]]) are often, but not always present. | ||
* Highly inconsistent fluctuations in the [[blood pressure]] can occur because of the variability in the degree of [[left atrium|left atrial]] (LA) contribution to LV filling, [[stroke volume]], and [[cardiac output]]. | * Highly inconsistent fluctuations in the [[blood pressure]] can occur because of the variability in the degree of [[left atrium|left atrial]] (LA) contribution to LV filling, [[stroke volume]], and [[cardiac output]]. | ||
===Neck=== | ===Neck=== | ||
* Intermittent [[cannon A waves]] can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction. | * Intermittent [[cannon A waves]] can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction. | ||
===Heart=== | ===Heart=== | ||
* Variability in the occurrence and intensity of [[heart sounds]] (especially [[S1]]) may also be observed and is heard more frequently when the rate of the [[tachycardia]] is slower. | * Variability in the occurrence and intensity of [[heart sounds]] (especially [[S1]]) may also be observed and is heard more frequently when the rate of the [[tachycardia]] is slower. | ||
* Look for evidence of preexisting conditions like a [[pacemaker]]/[[AICD]] or [[scar]] mark from previous cardiothoracic surgery. | * Look for evidence of preexisting conditions like a [[pacemaker]]/[[AICD]] or [[scar]] mark from previous cardiothoracic surgery. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 07:07, 6 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]
Overview
Physical examination should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. Jugular pulsation may be noted in the neck exam.
Physical Examination
Physical findings depend in part on the P-to-QRS relationship with/without signs of AV dissociation.[1]
Vital Signs
- Vitals are generally unaffected by carotid sinus massage, although this maneuver may slow the atrial rate and, in some cases, expose AV dissociation.
Blood Pressure
- Hemodynamic compromise (hypotension, shock) are often, but not always present.
- Highly inconsistent fluctuations in the blood pressure can occur because of the variability in the degree of left atrial (LA) contribution to LV filling, stroke volume, and cardiac output.
Neck
- Intermittent cannon A waves can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction.
Heart
- Variability in the occurrence and intensity of heart sounds (especially S1) may also be observed and is heard more frequently when the rate of the tachycardia is slower.
- Look for evidence of preexisting conditions like a pacemaker/AICD or scar mark from previous cardiothoracic surgery.