Diastolic dysfunction physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
==Physical Examination== | ==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=== | |||
* [[ankle edema|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. | |||
==References== | ==References== | ||
Revision as of 03:09, 21 October 2012
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Diastolic dysfunction Microchapters |
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Diastolic dysfunction physical examination On the Web |
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Risk calculators and risk factors for Diastolic dysfunction physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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
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
Extremities
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.