Ebsteins anomaly of the tricuspid valve physical examination: Difference between revisions
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{{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu] | {{CMG}} and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu] | ||
'''Associate Editor-In-Chief:''' {{CZ | '''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== | ==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== | ==Physical Examination== | ||
===Appearance=== | ===Appearance=== | ||
Patients may have a bluish coloration of their face depending on the degree of [[cyanosis]] and right to left shunting. | [[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 === | ===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. | |||
===Neuromuscular=== | |||
*[[Neuromuscular]] examination is usually normal in [[patients]] with ebstein's anomaly. | |||
* | |||
===Extremities=== | ===Extremities=== | ||
* [[Clubbing]] | * [[Clubbing]] | ||
* [[Cyanosis]] | * [[Cyanosis]] | ||
* Cool periphery | * [[Cool periphery]] | ||
==References== | ==References== | ||
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{{WS}} | {{WS}} | ||
[[Category: | [[Category:Cardiovascular system]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Congenital heart disease]] | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Disease]] | |||
Latest revision as of 17:51, 12 February 2020
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Ebsteins anomaly of the tricuspid valve Microchapters | |
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Diagnosis | |
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Treatment | |
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Case Studies | |
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Ebsteins anomaly of the tricuspid valve physical examination On the Web | |
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Risk calculators and risk factors for Ebsteins anomaly of the tricuspid valve physical examination | |
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
- 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 first and 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
Genitourinary
- Genitourinary examination is usually normal in patients with ebstein's anomaly.
Neuromuscular
- Neuromuscular examination is usually normal in patients with ebstein's anomaly.
Extremities