Dilated cardiomyopathy physical examination

Overview

Patients with dilated cardiomyopathy (DCM) usually appear lethargic and may display the general appearance of heart failure. Physical examination of patients with DCM is usually remarkable for cardiac examination findings (lateral displacement of the point of maximal impulse, right ventricular heave, S₂ at the base, and S3 gallops), jugular venous distension, and peripheral edema.

Physical Examination

Appearance of the Patient

• Patients with DCM usually appear lethargic and may display the general appearance of heart failure.

Vital Signs

• Tachycardia with regular or irregular pulse (in case of atrial fibrillation)
• Tachypnea
• Weak pulse (low pulse pressure)
• Low blood pressure may be present

Skin

• Cyanosis
• Pallor in case of heart failure.

HEENT

• HEENT examination of patients with DCM is usually normal

Neck

• Jugular venous distension

Lungs

• Fine crackles upon auscultation of the lung bases bilaterally

Heart

• Lateral displacement of the point of maximal impulse (PMI)
• Right ventricular heave
• S₂ at the base (paradoxical splitting, prominent P₂)
• S₃
• S₄
• S3 Gallops
• Atrial fibrillation may be present

Abdomen

• Hepatomegaly in heart failure

Back

• Back examination of patients with DCM is usually normal

Genitourinary

• Genitourinary examination of patients with DCM is usually normal.

Neuromuscular

• Neuromuscular examination of patients with DCM is usually normal

Extremities

• Cyanosis
• Clubbing
• Pitting edema of the upper/lower extremities in heart failure

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