Cardiogenic shock physical examination: Difference between revisions

Jump to navigation Jump to search
Line 32: Line 32:
In the particular case of [[right ventricle myocardial infarction]], the [[physical examination]] will generally reveal a clear [[lung]] [[auscultation]]. There will also often be a triad of [[signs]] (with poor [[sensitivity]] for [[diagnosis]]):
In the particular case of [[right ventricle myocardial infarction]], the [[physical examination]] will generally reveal a clear [[lung]] [[auscultation]]. There will also often be a triad of [[signs]] (with poor [[sensitivity]] for [[diagnosis]]):
*[[Hypotension]]
*[[Hypotension]]
*[[Jugular venous distention]]
*[[Jugular venous distention]]
*Clear [[lung sounds]]
*Clear [[lung sounds]]
There may also be findings of:
There may also be findings of:
*Tricuspid regurgitation
*[[Tricuspid regurgitation]]
*Right ventricle gallop
*[[Right ventricle]] gallop
*Atrio-ventricular block
*[[Complete AV block|Atrio-ventricular block]]
*[[Pulsus paradoxus]]
*[[Pulsus paradoxus]]
 
*[[Kussmaul's sign]], often present in [[constrictive pericarditis]]
*[[Kussmaul's sign]], often present in constrictive pericarditis
(The presence of increased [[JVP]] and [[Kussmaul's sign]] is both [[specificity|specific]] and [[sensitivity|sensitive]] for the [[diagnosis]] of [[right ventricle myocardial infarction]]).
(The presence of increased [[JVP]] and [[Kussmaul's sign]] is both [[specificity|specific]] and [[sensitivity|sensitive]] for the [[diagnosis]] of [[right ventricle myocardial infarction]]).



Revision as of 03:14, 23 May 2014

Cardiogenic Shock Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cardiogenic shock from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cardiogenic shock physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cardiogenic shock physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiogenic shock physical examination

CDC on Cardiogenic shock physical examination

Cardiogenic shock physical examination in the news

Blogs on Cardiogenic shock physical examination

Directions to Hospitals Treating Cardiogenic shock

Risk calculators and risk factors for Cardiogenic shock physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Attending to the catastrophic outcome of cardiogenic shock in a very short time span, its diagnosis must be reached as early as possible in order for proper therapy to be started. This period until diagnosis and treatment initiation is particularly important in the case of cardiogenic shock since the mortality rate of this condition complicating acute-MI is very high, along with the fact that the ability to revert the damage caused, through reperfusion techniques, declines considerably with diagnostic delays. Therefore and due to the unstable state of these patients, the diagnostic evaluations are usually performed as supportive measures are initiated. The diagnostic measures should start with the proper history and physical examination, including blood pressure beasurements, followed by an EKG, chest x-ray and collection of blood samples for evaluation. The physician should have in mind the common features of shock, irrespective of the type of shock, in order to avoid delays in the diagnosis. Although not all shock patients present in the same way, these features include: abnormal mental status, cool extremities, clammy skin, manifestations of hypoperfusion, such as hypotension and oliguria, as well as evidence of metabolic acidosis on the blood results.[1]

Physical Examination

Patients in cardiogenic shock, generally complicating acute-MI, often present to the hospital with signs of end-organ hypoperfusion, such as altered mentation and agitated. The typical physical examination may include:[2]

Vital Signs

Neck

Skin

Heart

Lungs

Genitourinary


In the particular case of right ventricle myocardial infarction, the physical examination will generally reveal a clear lung auscultation. There will also often be a triad of signs (with poor sensitivity for diagnosis):

There may also be findings of:

(The presence of increased JVP and Kussmaul's sign is both specific and sensitive for the diagnosis of right ventricle myocardial infarction).

References

  1. Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
  2. Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.


Template:WikiDoc Sources