Cardiac disease in pregnancy physical examination
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Cardiac disease in pregnancy Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]
Overview
Significant similarities exist between the normal signs of pregnancy and the presence of an underlying cardiac disease; hence poses a clinical challenge to differentiate between the two. However, common signs include: jugular venous distension, pulmonary rales, increased intensity of heart sounds and pedal edema.
Vitals
- Arterial pulses are high volume and collapsing in nature. Such collapsing pulse must be differentiated from other hyperdynamic states including aortic insufficiency and hyperthyroidism.
Neck
- Jugular venous distension may be present
Lungs
- Adventitious sounds such as basal rales may be appreciated
Heart
Heart Sounds:
- Increased intensity of the first heart sound secondary to physiologic hyperdynamic circulation during pregnancy
- Persistent split S2
- Third heart sound is uncommon
Murmur:
- Pulmonic midsystolic murmur
- Continuous murmur (mammary soufflé, cervical hum)
- In general there are often innocent murmurs of pregnancy. These are the result of a hyperkinetic circulation. These murmurs are usually midsystolic and soft and heard best at the left lower sternal border and over the pulmonic area.
Extremities
- Varicosities and ankle edema secondary to inferior vena caval compression