Total anomalous pulmonary venous connection physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief:Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3] Priyamvada Singh, MBBS [[4]] Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]

Overview

The physical finding depends on the degree of obstruction and the degree of left-to-right shunting.

Physical Examination

The physical examination in patients with total anomalous pulmonary venous connection depends on the following factors-

• Type of anatomic connection present between systemic and pulmonary venous circulation
• Degree of obstruction
• Type of obstruction (obstructed, unobstructed)
• Amount of right to left shunting

Vitals

Pulse

• Decreased pulses (low systemic blood flow)

Blood Pressure

• Hypotension (low systemic blood flow)

Respiratory Rate

• Tachypnea (right sided volume overload)
• Peripheral edema (right sided heart failure)

Heart

Inspection

• Precodial asymmetry indicating right ventricular hypertrophy

Palpation

• Right ventricular heave

Auscultation

• Prominent, Fixed split second heart sound (S2)
• S3 gallop
• Systolic ejection murmur at left upper sternal border. Ejection murmurs are more prominent in unobstructed TAPVC.
• Diastolic murmur due to tricuspid regurgitation

Abdomen

• Hepatomegaly

Extremities

• Cyanosis (right to left shunt)