Syncope physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Patients with syncope usually appear normal. Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.

Physical Examination

Patients with syncope usually appear normal.

Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.

Appearance of the Patient

• Patients with Syncope usually appear normal.

Vital Signs

• Tachycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, structural heart disease is the underlying cause of syncope.
• Bradycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, conductive heart disease is the underlying cause of syncope.
• Orthostatic hypotension may be present.

Skin

Skin examination of patients with syncope is usually normal. However, it may be remarkable for:

• Cyanosis
• Pallor

HEENT

• HEENT examination of patients with syncope is usually normal.

Neck

Neck examination of patients with syncope is usually normal. However, it may be remarkable for the following findings depending on the underlying cause of syncope:

• Jugular venous distension
• Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope.
• Hepatojugular reflux

Lungs

• Pulmonary examination of patients with syncope is usually normal.

Heart

Cardiovascular examination of patients with syncope is usually normal. However, if the underlying cause of the syncope is cardiovascular disease, it may be remarkable for:

• Heave / thrill
• S3
• S4
• Gallops
• A murmur may be heard using the stethoscope.

Abdomen

• Abdominal examination of patients with syncope is usually normal.

Genitourinary

• Genitourinary examination of patients with syncope is usually normal.

Neuromuscular

Neuromuscular examination of patients with syncope is usually normal. However, focal neurologic signs may be present if cerebrovascular events were misdiagnosed for syncope. These findings may include:

• Altered mental status
• Hyperreflexia
• Positive (abnormal) Babinski
• Muscle rigidity
• Proximal/distal muscle weakness unilaterally/bilaterally
• Unilateral/bilateral upper/lower extremity weakness
• Absent/present dysdiadochokinesia (palm tapping test)

Extremities

Extremities examination of patients with syncope is usually normal. It may be remarkable for the following findings depending on the underlying cause:

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities

References

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