Diastolic dysfunction physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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
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
Skin
- The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock
- Cyanosis is observed if severe hypoxemia is present
- Anasarca
Neck
- Jugular vein distention
- Central venous pressure > 16 cmH2O
Lungs
- Pleural effusion with dullness to percussion at the bases
- Rales
Heart
- If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.
Auscultation
- S3 and a gallop rhythm
- Underlying valvular heart disease causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated.
Abdomen
Extremities
Neurologic
- Confusion and altered mentation
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.