Palpitation physical examination: Difference between revisions

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Revision as of 19:47, 6 August 2020

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

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural heard disease, substance abuse or psychiatric disorders.

Appearance of the Patient

Patients with palpitations may or may not be in distress as it is typically a transient symptom.
Patient may exhibit aggressive/aberrant behavior suggestive of possible substance abuse.
Patients with a psychiatric disorder such as generalized anxiety disorder may present with psychomotor agitation or an anxious demeanor.

Vital Signs

Tachycardia with regular pulse or irregularly irregular pulse
An irregular pulse may indicate atrial fibrillation or atrial flutter.
A regular pulse may indicate sinus tachycardia or paroxysmal supraventricular tachycardia.
Bradycardia with regular pulse or irregularly irregular pulse – very rarely seen
Pulse discrepancy / Radio-femroal delay - Coarctation of aorta
Tachypnea – Hyperventilation seen in panic disorder
Bradypnea – Respiratory depression secondary to substance abuse
Possible signs of orthostatic hypotension – Dehydration or electrolyte imbalance.

Skin

Heat intolerance – Hyperthyroidism
Cold intolerance – Hypothyroidism
Dry skin with discoloration – Hypothyroidism
Diaphoresis – Substance abuse,hyperthyroidism
Pallor – Anemia

HEENT

Exophthalmos – Hyperthyroidism
Pupils may be dilated – Indicative of substance abuse ; cocaine, amphetamines

Neck

Jugular venous distension – secondary to congestive heart failure
Thyromegaly / thyroid nodules – causing hyperthyroidism/ hypothyroidism
Hepatojugular reflux – Indicative of constrictive pericarditis, restrictive cardiomyopathy or right heart failure.
Pounding pulsations – may be seen in AV nodal re-entry tachycardia

Lungs

Fine/coarse bibasilar crackles upon auscultation – Congestive heart failure

Heart

Displaced point of maximal impulse (PMI) suggestive of left ventricular hypertrophy or cardiomegaly.
Friction rub – Pericarditis
S2 – fixed splitting of S2 along with a right ventricular heave is indicative of an atrial septal defect
S3 – Congestive heart failure
S4 – Chronic valvular heart disease
A harsh pansystolic murmur best heard over the left sternal border and increases with Vasalva – Hypertrophic cardiomyopathy.
Mid systolic click - Mitral valve prolapse
Systolic murmur best heard over the pulmonic area – Pulmonic stenosis

Abdomen

Ascites – Right heart failure
Congestive hepatomegaly

Back

Back examination of patients with palpitations is usually normal.

Genitourinary

Genitourinary examination of patients with palpitations is usually normal.

Neuromuscular

Patient is usually oriented to persons, place, and time
Altered mental status – Myxedema madness, alcohol consumption
Hyperreflexia – Hyperthyroidism
Hyporeflexia – Hypothyroidism
Proximal/distal muscle weakness unilaterally/bilaterally – Hypothyroidism
Unilateral/bilateral tremor – Hyperthyroidism

Extremities

Pitting edema – Congestive heart failure

References

Template:WikiDoc Sources

@@ Line 20: / Line 20: @@
 ==Physical Examination==
-Physical examination of patients with [disease name] is usually normal.
-OR
-Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
+Physical examination of patients with palpitations may be normal or have findings suggestive of thyroid dysfunction, congestive heart failure, structural heard disease, substance abuse or psychiatric disorders.
-OR
+=== Appearance of the Patient ===
-The presence of [finding(s)] on physical examination is diagnostic of [disease name].
+* Patients with palpitations may or may not be in distress as it is typically a transient symptom.
+* Patient may exhibit aggressive/aberrant behavior suggestive of possible substance abuse.
+* Patients with a psychiatric  disorder such as generalized anxiety disorder may present with psychomotor agitation or an anxious demeanor.
-OR
+=== Vital Signs ===
-The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
+* [[Tachycardia]] with regular pulse or irregularly irregular pulse
+* An irregular pulse may indicate atrial fibrillation or atrial flutter.
+* A regular pulse may indicate sinus tachycardia or paroxysmal supraventricular tachycardia.
+* [[Bradycardia]] with regular pulse or irregularly irregular pulse – very rarely seen
+* Pulse discrepancy / Radio-femroal delay  - Coarctation     of aorta
+* Tachypnea –  Hyperventilation seen in panic disorder
+* Bradypnea – Respiratory depression secondary to substance abuse
+* Possible signs of orthostatic hypotension – Dehydration or electrolyte     imbalance.
-===Appearance of the Patient===
+=== Skin ===
-*Patients with [disease name] usually appear [general appearance].
-===Vital Signs===
+* Heat intolerance – Hyperthyroidism
+* Cold intolerance – Hypothyroidism
+* Dry skin with discoloration – Hypothyroidism
+* Diaphoresis – Substance abuse,hyperthyroidism
+* [[Pallor]] – Anemia
-*High-grade / low-grade fever
+=== HEENT ===
-*[[Hypothermia]] / hyperthermia may be present
-*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
-*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
-*Tachypnea / bradypnea
-*Kussmal respirations may be present in _____ (advanced disease state)
-*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
-*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
-===Skin===
+* Exophthalmos – Hyperthyroidism
-* Skin examination of patients with [disease name] is usually normal.
+* Pupils may be dilated – Indicative of substance abuse ; cocaine, amphetamines
-OR
-*[[Cyanosis]]
-*[[Jaundice]]
-* [[Pallor]]
-* Bruises
-<gallery widths="150px">
+=== Neck ===
-UploadedImage-01.jpg | Description {{dermref}}
+* [[Jugular venous distension]] – secondary to congestive heart failure
-UploadedImage-02.jpg | Description {{dermref}}
+* [[Thyromegaly]] / thyroid nodules – causing hyperthyroidism/ hypothyroidism
+* [[Hepatojugular reflux]] – Indicative of constrictive pericarditis, restrictive cardiomyopathy or right heart failure.
+* Pounding pulsations – may be seen in AV nodal re-entry tachycardia
-</gallery>
+=== Lungs ===
-===HEENT===
+* Fine/coarse bibasilar [[crackles]] upon auscultation – Congestive heart failure
-* HEENT examination of patients with [disease name] is usually normal.
-OR
-* Abnormalities of the head/hair may include ___
-* Evidence of trauma
-* Icteric sclera
-* [[Nystagmus]]
-* Extra-ocular movements may be abnormal
-*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
-*Ophthalmoscopic exam may be abnormal with findings of ___
-* Hearing acuity may be reduced
-*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
-*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
-* [[Exudate]] from the ear canal
-* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
-*Inflamed nares / congested nares
-* [[Purulent]] exudate from the nares
-* Facial tenderness
-* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
-===Neck===
+=== Heart ===
-* Neck examination of patients with [disease name] is usually normal.
-OR
-*[[Jugular venous distension]]
-*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
-*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
-*[[Thyromegaly]] / thyroid nodules
-*[[Hepatojugular reflux]]
-===Lungs===
+* Displaced point of  maximal impulse (PMI) suggestive of left ventricular hypertrophy or  cardiomegaly.
-* Pulmonary examination of patients with [disease name] is usually normal.
+* [[Friction rub]] – Pericarditis
-OR
+* [[Heart sounds#Second heart tone S2 the %22dub%22(components A2 and P2)|S2]] – fixed splitting of S2 along with a right ventricular heave is indicative of an atrial septal defect
-* Asymmetric chest expansion OR decreased chest expansion
+* [[Heart sounds#Third heart sound S3|S3]] – Congestive heart failure
-*Lungs are hyporesonant OR hyperresonant
+* [[Heart sounds#Fourth heart sound S4|S4]] –  Chronic valvular heart disease
-*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
+* A harsh pansystolic murmur best heard over the left sternal border and increases with Vasalva –  Hypertrophic cardiomyopathy.
-*Rhonchi
+* Mid systolic click - Mitral valve prolapse
-*Vesicular breath sounds OR distant breath sounds
+* Systolic murmur best heard  over the pulmonic area – Pulmonic stenosis
-*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
-*[[Wheezing]] may be present
-*[[Egophony]] present/absent
-*[[Bronchophony]] present/absent
-*Normal/reduced [[tactile fremitus]]
-===Heart===
+=== Abdomen ===
-* Cardiovascular examination of patients with [disease name] is usually normal.
-OR
-*Chest tenderness upon palpation
-*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
-*[[Heave]] / [[thrill]]
-*[[Friction rub]]
-*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
-*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
-*[[Heart sounds#Third heart sound S3|S3]]
-*[[Heart sounds#Fourth heart sound S4|S4]]
-*[[Heart sounds#Summation Gallop|Gallops]]
-*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
-===Abdomen===
+* Ascites – Right heart failure
-* Abdominal examination of patients with [disease name] is usually normal.
+* Congestive hepatomegaly
-OR
-*[[Abdominal distension]]
-*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
-*[[Rebound tenderness]] (positive Blumberg sign)
-*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
-*Guarding may be present
-*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
-*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
-===Back===
+=== Back ===
-* Back examination of patients with [disease name] is usually normal.
-OR
-*Point tenderness over __ vertebrae (e.g. L3-L4)
-*Sacral edema
-*Costovertebral angle tenderness bilaterally/unilaterally
-*Buffalo hump
-===Genitourinary===
+* Back examination of patients with palpitations is usually normal.
-* Genitourinary examination of patients with [disease name] is usually normal.
-OR
-*A pelvic/adnexal mass may be palpated
-*Inflamed mucosa
-*Clear/(color), foul-smelling/odorless penile/vaginal discharge
-===Neuromuscular===
+=== Genitourinary ===
-* Neuromuscular examination of patients with [disease name] is usually normal.
-OR
-*Patient is usually oriented to persons, place, and time
-* Altered mental status
-* Glasgow coma scale is ___ / 15
-* Clonus may be present
-* Hyperreflexia / hyporeflexia / areflexia
-* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
-* Muscle rigidity
-* Proximal/distal muscle weakness unilaterally/bilaterally
-* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
-*Unilateral/bilateral upper/lower extremity weakness
-*Unilateral/bilateral sensory loss in the upper/lower extremity
-*Positive straight leg raise test
-*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
-*Positive/negative Trendelenburg sign
-*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
-*Normal finger-to-nose test / Dysmetria
-*Absent/present dysdiadochokinesia (palm tapping test)
-===Extremities===
+* Genitourinary examination of patients with palpitations is usually normal.
-* Extremities examination of patients with [disease name] is usually normal.
-OR
+=== Neuromuscular ===
-*[[Clubbing]]
-*[[Cyanosis]]
+* Patient is usually oriented to persons, place, and time
-*Pitting/non-pitting [[edema]] of the upper/lower extremities
+* Altered mental status – Myxedema madness, alcohol consumption
-*Muscle atrophy
+* Hyperreflexia –  Hyperthyroidism
-*Fasciculations in the upper/lower extremity
+* Hyporeflexia –  Hypothyroidism
+* Proximal/distal muscle weakness unilaterally/bilaterally – Hypothyroidism
+* Unilateral/bilateral tremor – Hyperthyroidism
+=== Extremities ===
+* Pitting edema – Congestive heart failure
 ==References==