Diastolic dysfunction physical examination: Difference between revisions

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==Overview==
==Overview==
In general, signs of both [[left sided heart failure]] and [[right sided heart failure]] are present. There is often [[jugular venous distension]] due to dysfunction of the right ventricle and [[pulmonary edema]] due to left ventricular diastolic dysfunction.
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==
==Physical Examination==
===Appearance of the Patient===
===Appearance of the Patient===
* The patient is often sitting upright and there may be labored breathing during an acute episode.
* 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.
* The patient's weight should be recorded to ascertain how far they are from their "dry" weight
===Vitals===
===Vitals===
====Pulse====
====Pulse====
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====Blood Pressure====
====Blood Pressure====
*A [[narrow pulse pressure]] (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present.
*A [[narrow pulse pressure]] (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present
 
====Respiratory Rate====
====Respiratory Rate====
* [[Tachypnea]] (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure
* [[Tachypnea]] (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure
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===Lungs===
===Lungs===
* [[Pleural effusion]] with dullness to percussion at the bases
* [[Pleural effusion]] with dullness to percussion at the bases may be present in both acute and chronic heart failure
* [[Rales]]
* [[Rales]] is often present in both acute and chronic heart failure
 
===Heart===
===Heart===
* If the right ventricular pressure is increased, a [[parasternal heave]] may be present, signifying the compensatory increase in contraction strength.
* If the right ventricular pressure is increased, a [[parasternal heave]] may be present, signifying the compensatory increase in contraction strength.
====Auscultation====
====Auscultation====
* [[S3]] and a [[gallop rhythm]]
* [[S3]] and a [[gallop rhythm]]
* Underlying [[valvular heart disease]] causes of diastolic heart failure such as [[mitral stenosis]], and [[aortic stenosis]] may be auscultated.
* Underlying [[valvular]] causes of diastolic heart failure such as [[mitral stenosis]], and [[aortic stenosis]] may be auscultated
 
===Abdomen===
===Abdomen===
* [[Hepatojugular reflux]]
* [[Hepatojugular reflux]]
* [[Hepatomegaly]]
* [[Hepatomegaly]] may be present as a result of chronic heart failure
* [[Ascites]]
* [[Ascites]] may be present as a result of chronic heart failure
 
===Extremities===
===Extremities===
* [[ankle edema|Bilateral ankle edema]]  
* [[ankle edema|Bilateral ankle edema]] may be present as a result of chronic heart failure
 
===Neurologic===
===Neurologic===
* [[Confusion]] and altered mentation
* [[Confusion]] and altered mentation may be present in the setting of acute heart failure
 
Signs that represent 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]].  Commonly signs of both left and right sided failure are present.


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Categor:Best pages]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date]]

Latest revision as of 12:07, 30 January 2013

Diastolic dysfunction Microchapters

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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

Neck

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

Abdomen

Extremities

Neurologic

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

References

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