Third degree AV block physical examination: Difference between revisions

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* Basilar [[rales]] may be heard.
* Basilar [[rales]] may be heard.
*
*
*Pulmonary examination of patients with third degree AV block is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
Line 63: Line 50:
===Abdomen===
===Abdomen===
* Abdominal examination of patients with third degree AV block is usually normal.
* Abdominal examination of patients with third degree AV block is usually normal.
OR
 
*[[Abdominal distension]]
*Nevertheless it depends to the basic etiology, for example in other rare etiologies of complete heart block such as  infectious- rheumatologic / granolomatosis disease or amyloid disease the following findings might be present:
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Hepatomegaly]]  
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Splenomegaly]]  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*H[[hepatosplenomegaly|epatosplenomegaly]]
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with third degree AV block is usually normal.
* Back examination of patients with third degree AV block is usually normal.
OR
 
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema ight be present in heart failure
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with third degree AV block is usually normal.
* Genitourinary examination of patients with third degree AV block is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with third degree AV block is usually normal.
* Neuromuscular examination of patients with third degree AV block is usually normal.
OR
 
*Patient is usually oriented to persons, place, and time
*In rare etiologies of complete heart block such as  infectious, rheumatologic, granolomatosis disease or amyloid disease abnormal findings might be present such as:
* Altered mental status
* Altered mental status
* Glasgow coma scale is ___ / 15
* Glasgow coma scale is ___ / 15

Revision as of 12:46, 28 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Raviteja Guddeti, M.B.B.S. [3] ; Aditya Ganti M.B.B.S. [4]

Overview

The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill.

Physical Examination

Physical examination of patients with third degree AV block is usually remarkable for bradycardia, hypotension and hypoperfusion plus/minus sign and symptoms of heart failure such as edema, pulmonary rales, and S3 gollop. In the presence of primary etiology and secondary heart block such as myocardial infarction or Lyme disease other sign and symptoms such as rash or chest pain might be present as well.

Appearance of the Patient

Vital Signs

  • Bradycardia may be present.
  • Tachypnea may be present.
  • Patients might be febrile (Lyme disease, endocarditis)


Skin

Classic Lyme disease rash - Source: CDC.gov
Disseminated Lyme disease, multiple rash - Source: CDC.gov

HEENT

  • HEENT examination of patients with third degree AV block is usually normal.
  • Cyanosis might be present.

Neck

Lungs

  • Basilar rales may be heard.

Heart

Abdomen

  • Abdominal examination of patients with third degree AV block is usually normal.
  • Nevertheless it depends to the basic etiology, for example in other rare etiologies of complete heart block such as infectious- rheumatologic / granolomatosis disease or amyloid disease the following findings might be present:
  • Hepatomegaly
  • Splenomegaly
  • Hepatosplenomegaly

Back

  • Back examination of patients with third degree AV block is usually normal.
  • Sacral edema ight be present in heart failure

Genitourinary

  • Genitourinary examination of patients with third degree AV block is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with third degree AV block is usually normal.
  • In rare etiologies of complete heart block such as infectious, rheumatologic, granolomatosis disease or amyloid disease abnormal findings might be present such as:
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities

  • Pedal edema may be present.
  • Extremities examination of patients with third degree AV block is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity


References

  1. Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H (July 1999). "The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik study". J. Intern. Med. 246 (1): 81–6. doi:10.1046/j.1365-2796.1999.00521.x. PMID 10447229.
  2. Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H (January 1998). "[Third degree atrioventricular block.]". Laeknabladid (in Icelandic). 84 (1): 8–15. PMID 19667425.


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