Eisenmenger’s syndrome physical examination: Difference between revisions

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==Overview==
==Overview==
The general examination of patients with Eisenmenger's syndrome may show [[cyanosis]], dermal changes, [[clubbing]], [[peripheral edema]], and abdominal swelling. Cardiac examination may show [[A wave]] dominant [[Jugular venous pressure|jugular venous pulse]], right ventricular [[heave]], high-pitched early diastolic [[Heart murmur|murmur]] of [[pulmonary insufficiency]], right-sided [[S4]], pulmonary ejection click, single palpable [[S2|S<sub>2</sub>]], and loud [[P2|P<sub>2</sub>]].


==Physical Examination==
==Physical Examination==
The physical examination of patients with [[Eisenmenger's syndrome]] may show the following<ref name="pmid22043211">{{cite journal| author=Kaemmerer H, Mebus S, Schulze-Neick I, Eicken A, Trindade PT, Hager A et al.| title=The adult patient with eisenmenger syndrome: a medical update after dana point part I: epidemiology, clinical aspects and diagnostic options. | journal=Curr Cardiol Rev | year= 2010 | volume= 6 | issue= 4 | pages= 343-55 | pmid=22043211 | doi=10.2174/157340310793566154 | pmc=3083816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22043211  }}</ref><ref name="pmid201964692">{{cite journal| author=Iveta S| title=Eisenmenger syndrome--a unique form of pulmonary arterial hypertension. | journal=Bratisl Lek Listy | year= 2009 | volume= 110 | issue= 12 | pages= 757-64 | pmid=20196469 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20196469  }}</ref><ref name="pmid9556469">{{cite journal| author=Vongpatanasin W, Brickner ME, Hillis LD, Lange RA| title=The Eisenmenger syndrome in adults. | journal=Ann Intern Med | year= 1998 | volume= 128 | issue= 9 | pages= 745-55 | pmid=9556469 | doi=10.7326/0003-4819-128-9-199805010-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9556469  }}</ref>:


=== Appearance of the Patient ===
=== Appearance of the Patient ===


* Patients with [disease name] usually appear [general appearance].
* Patients with [[Eisenmenger's syndrome]] usually appear lethargic and cyanotic.


=== Vital Signs ===
=== Vital Signs ===


* [[Hypothermia]] / hyperthermia may be present
* [[Tachycardia]]  
* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]]
* [[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Postural hypotension]]
* Tachypnea / bradypnea
* Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
* High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


=== Skin ===
=== Skin ===
Skin examination of patients with Eisenmenger's syndrome usually shows:


* Skin examination of patients with [disease name] is usually normal.
*[[Plethora]]
*[[Livedo reticularis]]
*Profound [[acrocyanosis]]
*[[Urate]] depositions
*[[Ecchymosis]]
*Ischemic skin [[ulcerations]]


=== HEENT ===
=== HEENT ===


* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with [[Eisenmenger's syndrome]] is usually normal.


=== Neck ===
=== Neck ===


* [[Jugular venous distension]]
* [[Jugular venous distension]]
* [[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* [[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Thyromegaly]] / thyroid nodules
* [[Hepatojugular reflux]]
* [[Hepatojugular reflux]]


=== Lungs ===
=== Lungs ===


* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with [[Eisenmenger's syndrome]] is usually normal.


===Heart===
===Heart===
* Jugular venous pressure may be raised with 'a' wave indicating increased right atrial pressure. A 'v' wave indicating development of tricuspid regurgitation may also be seen
 
* Right ventricular heave and thrill
* [[Jugular venous pressure|Jugular venous pulse]] wave may be [[A wave]] dominant
* Murmurs of tricuspid and pulmonic regurgitation maybe audible.
* Precordial palpation reveals a right ventricular [[heave]]
* Loud P2
* High-pitched early diastolic [[Heart murmur|murmur]] of [[pulmonary insufficiency]]
* Ejection click
* Right-sided [[S4]]
* Pulmonary ejection click
* Single palpable [[S2|S<sub>2</sub>]]
* Loud [[P2|P<sub>2</sub>]]


===Abdomen===
===Abdomen===
* [[Hepatomegaly]]
* [[Hepatomegaly]]
* [[Ascites]]
*[[Jaundice]]
*Right upper abdominal quadrant [[tenderness]]


=== Back ===
=== Back ===


* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with [[Eisenmenger's syndrome]] is usually normal.


=== Genitourinary ===
=== Genitourinary ===


* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with [[Eisenmenger's syndrome]] is usually normal.


=== Neuromuscular ===
=== Neuromuscular ===


* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with [[Eisenmenger's syndrome]] is usually normal.


===Extremities===
===Extremities===
* Central [[cyanosis]]
* C[[cyanosis|yanosis]]
* [[Clubbing]]  
* [[Clubbing]]  
* Peripheral [[edema]]
* Peripheral [[edema]]


[[File:ClubbingFingers1.jpg|center|thumb|Nail clubbing of fingers in a patient with Eisenmenger's syndrome. Case courtsey of Ann McGrath [Public domain].<ref>https://en.wikipedia.org/wiki/Eisenmenger%27s_syndrome#/media/File:ClubbingFingers1.jpg/</ref>]]
<br />
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 15:01, 20 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

The general examination of patients with Eisenmenger's syndrome may show cyanosis, dermal changes, clubbing, peripheral edema, and abdominal swelling. Cardiac examination may show A wave dominant jugular venous pulse, right ventricular heave, high-pitched early diastolic murmur of pulmonary insufficiency, right-sided S4, pulmonary ejection click, single palpable S2, and loud P2.

Physical Examination

The physical examination of patients with Eisenmenger's syndrome may show the following[1][2][3]:

Appearance of the Patient

Vital Signs

Skin

Skin examination of patients with Eisenmenger's syndrome usually shows:

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

Nail clubbing of fingers in a patient with Eisenmenger's syndrome. Case courtsey of Ann McGrath [Public domain].[4]


References

  1. Kaemmerer H, Mebus S, Schulze-Neick I, Eicken A, Trindade PT, Hager A; et al. (2010). "The adult patient with eisenmenger syndrome: a medical update after dana point part I: epidemiology, clinical aspects and diagnostic options". Curr Cardiol Rev. 6 (4): 343–55. doi:10.2174/157340310793566154. PMC 3083816. PMID 22043211.
  2. Iveta S (2009). "Eisenmenger syndrome--a unique form of pulmonary arterial hypertension". Bratisl Lek Listy. 110 (12): 757–64. PMID 20196469.
  3. Vongpatanasin W, Brickner ME, Hillis LD, Lange RA (1998). "The Eisenmenger syndrome in adults". Ann Intern Med. 128 (9): 745–55. doi:10.7326/0003-4819-128-9-199805010-00008. PMID 9556469.
  4. https://en.wikipedia.org/wiki/Eisenmenger%27s_syndrome#/media/File:ClubbingFingers1.jpg/

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