Ebsteins anomaly of the tricuspid valve physical examination: Difference between revisions

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{{Template:ebstein's anomaly of the tricuspid valve}}
__NOTOC__
{{Template:Ebstein's anomaly of the tricuspid valve}}
 
{{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]
{{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]
__NOTOC__
'''Associate Editor-In-Chief:''' {{CZ}}


===[[Ebstein's anomaly of the tricuspid valve physical examination|Physical Examination]]===
'''Associate Editor-In-Chief:''' {{CZ}}; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com] '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
 
==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 vein|jugular veins]] can be seen in these [[Patient|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 second heart sound|split]] first and [[Second heart sound|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===
*[[Back]] examination is usually normal in [[patients]] with ebstein's anomaly.
 
===Genitourinary===
*[[Genitourinary]] examination is usually normal in [[patients]] with ebstein's anomaly.


====General Appearance====
===Neuromuscular===
Patients may have a bluish coloration of their face depending on the degree of [[cyanosis]] and right to left shunting.
*[[Neuromuscular]] examination is usually normal in [[patients]] with ebstein's anomaly.


==== Heart ====
===Extremities===
Because the RA is dilated and compliant, there are no large v waves even in the presence of TR ([[tricuspid regurgitation]]) and the jugular venous pressure is often normal on exam. The chest may be asymmetric due to an enlarged right heart.
* [[Clubbing]]
* [[Cyanosis]]
* [[Cool periphery]]


The first heart sound is widely split. There is a wide split S2 as a result of [[RBBB]] and delayed closure of the pulmonic valve. TR ([[tricuspid regurgitation]]), produces a holosystolic murmur which is heard best along the left lower sternal border and increases with inspiration.


==References==
==References==
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{{Congenital malformations and deformations of circulatory system}}
{{Congenital malformations and deformations of circulatory system}}
[[Category:DiseaseState]]
{{WH}}
{{WS}}
 
[[Category:Cardiovascular system]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
 
[[Category:Disease]]
{{WH}}
 
{{WS}}

Latest revision as of 17:51, 12 February 2020

Ebsteins anomaly of the tricuspid valve Microchapters

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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

Palpation

Auscultation

  • Click sound may be heard due to abnormal movement of the anterior leaflet.

Lung

Abdomen

Back

  • Back examination is usually normal in patients with ebstein's anomaly.

Genitourinary

Neuromuscular

Extremities


References

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