Tuberculous pericarditis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Fahimeh Shojaei, M.D. Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Patients with tuberculous pericarditis usually appear Cachectic. They may have fever, tachycardia, pulsus paradoxus, hypotension, tachypnea, JVP distension, kussmaul's sign, lymphadenopathy, ankle edama, pleura dullness, decreased breath sounds, pericardial knock, pericardial rub, fine/coarse crackles upon auscultation of the lung, hepatomegaly, ascites, distant heart sounds, displaced point of maximal impulse (PMI) suggestive of cardiomegaly, friction rub, and S4.

Physical Examination

Appearance of the Patient

Patients with tuberculous pericarditis usually appear Cachectic.^[1]^[2]

Vital Signs

Fever
Tachycardia
Pulsus paradoxus
Hypotension (in cardiac tamponade)
Tachypnea

Skin

Skin examination of patients with tuberculous pericarditis is usually normal.

HEENT

HEENT examination of patients with tuberculous pericarditis is usually normal.

Neck

Lungs

Pleura dullness
Decreased breath sounds
Pericardial knock
Pericardial rub
Fine/coarse crackles upon auscultation of the lung

Heart

Distant heart sounds
Displaced point of maximal impulse (PMI) suggestive of cardiomegaly
Friction rub
S4
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

Hepatomegaly
Ascites

Back

Back examination of patients with tuberculous pericarditis is usually normal.

Genitourinary

Genitourinary examination of patients with tuberculous pericarditis is usually normal.

Neuromuscular

Neuromuscular examination of patients with tuberculous pericarditis is usually normal.

Extremities

Pitting edema of the lower extremities

References

↑ Fowler NO, Manitsas GT (1973). "Infectious pericarditis". Prog Cardiovasc Dis. 16 (3): 323–36. doi:10.1016/s0033-0620(73)80004-0. PMID 4593515.
↑ Mayosi, Bongani M; Wiysonge, Charles Shey; Ntsekhe, Mpiko; Volmink, Jimmy A; Gumedze, Freedom; Maartens, Gary; Aje, Akinyemi; Thomas, Baby M; Thomas, Kandathil M; Awotedu, Abolade A; Thembela, Bongani; Mntla, Phindile; Maritz, Frans; Blackett, Kathleen Ngu; Nkouonlack, Duquesne C; Burch, Vanessa C; Rebe, Kevin; Parish, Andy; Sliwa, Karen; Vezi, Brian Z; Alam, Nowshad; Brown, Basil G; Gould, Trevor; Visser, Tim; Shey, Muki S; Magula, Nombulelo P; Commerford, Patrick J (2006). "Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry". BMC Infectious Diseases. 6 (1). doi:10.1186/1471-2334-6-2. ISSN 1471-2334.

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[pmid4593515-1] Fowler NO, Manitsas GT (1973). "Infectious pericarditis". Prog Cardiovasc Dis. 16 (3): 323–36. doi:10.1016/s0033-0620(73)80004-0. PMID 4593515.

[MayosiWiysonge2006-2] Mayosi, Bongani M; Wiysonge, Charles Shey; Ntsekhe, Mpiko; Volmink, Jimmy A; Gumedze, Freedom; Maartens, Gary; Aje, Akinyemi; Thomas, Baby M; Thomas, Kandathil M; Awotedu, Abolade A; Thembela, Bongani; Mntla, Phindile; Maritz, Frans; Blackett, Kathleen Ngu; Nkouonlack, Duquesne C; Burch, Vanessa C; Rebe, Kevin; Parish, Andy; Sliwa, Karen; Vezi, Brian Z; Alam, Nowshad; Brown, Basil G; Gould, Trevor; Visser, Tim; Shey, Muki S; Magula, Nombulelo P; Commerford, Patrick J (2006). "Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry". BMC Infectious Diseases. 6 (1). doi:10.1186/1471-2334-6-2. ISSN 1471-2334.

[1]

[2]