Ebsteins anomaly of the tricuspid valve physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Priyamvada Singh, MBBS [4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]
Overview
Ebstein's anomaly is characterized by tricuspid regurgitation and variable degrees a cyanosis depending upon the magnitude of right to left shunting and elevation of the jugular venous pressure is often present. A palpable prominent diffuse apical impulse may be felt. A holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border that increases with inspiration as well as a mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve.
Physical Examination
Appearance
Patients may have a bluish coloration of their face depending on the degree of cyanosis and right to left shunting.
Vitals
The pulse may be weak due to right sided heart failure.
Skin
Skin examination is usually normal in patients with ebstein's anomaly.
Neck
Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen.
Heart
Inspection
- The chest may be asymmetric due to an enlarged right heart.
- An apical impulse may be appreciated.
Palpation
- A palpable prominent diffuse apical impulse may be felt.
- A systolic thrill may be heard at the left lower sternal border.
- Right ventricular lift is subtle due to the small size of the right ventricle.
Auscultation
- Widely split first and second heart sounds may be appreciated due to right bundle branch block which is sometimes seen with this condition.
- A loud first heart sound (S1) of tricuspid regurgitation.
- A prominent S3 and S4 may be appreciated.
- A holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border that increases with inspiration as well as a mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve.
- Click sound may be heard due to abnormal movement of the anterior leaflet.
Lung
- Lung examination is usually normal in patients with ebstein's anomaly.
Abdomen
- Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure.
Back
Genitourinary
- Genitourinary examination is usually normal in patients with ebstein's anomaly.
Neuromuscular
- Neuromuscular examination is usually normal in patients with ebstein's anomaly.
Extremities