Diastolic dysfunction physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]

Overview

In general, signs of both left sided heart failure and right sided heart failure are present. Signs that represent acute 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.

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 may be present during an episode of acute heart failure

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 may be present during an episode of acute heart failure

Skin

• The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock may be present during an episode of acute heart failure
• Cyanosis is observed if severe hypoxemia is present during an episode of acute heart failure
• Anasarca may be present due to chronic heart failure

Neck

• Jugular vein distention is often present in both acute and chronic heart failure
• Central venous pressure > 16 cmH₂O is often present in both acute and chronic heart failure

Lungs

• Pleural effusion with dullness to percussion at the bases may be present in both acute and chronic heart failure
• Rales is often present in both acute and chronic heart failure

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 causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated

Abdomen

• Hepatojugular reflux
• Hepatomegaly may be present as a result of chronic heart failure
• Ascites may be present as a result of chronic heart failure

Extremities

• Bilateral ankle edema may be present as a result of chronic heart failure

Neurologic

• Confusion and altered mentation may be present in the setting of acute heart failure