Cardiac disease in pregnancy physical examination
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Normal physical exam signs of pregnancy include an "innocent" systolic flow murmur in 96% of patients due to the hyperdaynamic circulation, a diastolic murmur in 18% of patients, jugular venous distension and a displaced cardiac apex due to volume expansion, an S3 in 84% of patients, an occasional S4, varicose veins and pedal edema.
- Arterial pulses are high volume and collapsing in nature. Such collapsing pulse must be differentiated from other hyperdynamic states including aortic insufficiency and hyperthyroidism.
- The carotid upstroke is brisk due to the volume expansion and hyperdynamic state
- Jugular venous distension may be present due to the volume expansion
- Increased intensity of the first heart sound secondary to physiologic hyperdynamic circulation during pregnancy
- An S4 is occasionally heard
- An S3 is heard in 84% of cases
- 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.
- A systolic murmur is heard in 96% of patients, and a diastolic murmur is heard in 18% of patients.
- Pulmonic midsystolic murmur
- Continuous murmur (mammary soufflé, cervical hum)
- Adventitious sounds such as basal rales may be appreciated