Atrial flutter physical examination: Difference between revisions

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{{Atrial flutter}}
{{Atrial flutter}}
{{CMG}}
{{CMG}} {{AE}} {{F.K}}
 
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==Overview==
==Overview==
The patient should first be assessed for hemodynamic instability.  The patient should also be examined for the presence of reversible causes of atrial flutter.
[[Physical examination]] of patients with atrial flutter may reveal tachycardia, [[hypotension]], [[diaphoresis]], and evidence of [[congestive heart failure]]. Occasionally, [[cardiac auscultation]] may reveal an irregular rhythm, abnormal valve sounds, or a [[Gallop rhythm|gallop]].  


==Physical Examination==
==Physical Examination==
===Vitals===
[[Physical examination]] of patients with atrial flutter may reveal tachycardia, [[hypotension]], [[diaphoresis]], and evidence of [[congestive heart failure]]. Occasionally, [[cardiac auscultation]] may reveal an irregular rhythm, abnormal valve sounds, or a [[Gallop rhythm|gallop]].<ref name="pmid4698205">{{cite journal |vauthors=Wills RA |title=As a factor influencing patron retention |journal=J Am Pharm Assoc |volume=13 |issue=5 |pages=262–3 |date=May 1973 |pmid=4698205 |doi=10.1016/s0003-0465(16)32574-5 |url=}}</ref><ref name="pmid5522718">{{cite journal |vauthors=Apgar V |title=Genetic counseling. Remarks of moderator. Afternoon session |journal=Birth Defects Orig. Artic. Ser. |volume=6 |issue=1 |pages=41 |date=May 1970 |pmid=5522718 |doi= |url=}}</ref>
====Temperature====
[[Fever]] may be present.
 
====Pulse====
Pulse is usually rapid and may be regular or irregular.  Ventricular rate is around 150 beats per minute because of 2:1 conduction.  1:1 ventricular conduction is fatal.
 
====Blood pressure====
[[Hypertension]] may be present.
 
===Head and Neck===
[[Exophthalmos]] and neck swelling can be seen in [[hyperthyroidism]].
 
===Heart===
====Auscultation====
[[Heart sounds#Third heart sound S3|S3]] may be heard in congestive heart failure. A mid-to-late systolic click is present, followed by a late systolic [[heart sounds|murmur]] which is best heard at the cardiac apex is observed in [[mitral valve prolapse]]. Similarly a holosystolic murmur is heard in mitral regurgitation due to rheumatic heart disease.
 
 
 
Physical examination of patients with [disease name] is usually normal.
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with atrial flutter usually appear normal.  


===Vital Signs===
===Vital Signs===
 
*[[Tachycardia]] with regular pulse or irregular pulse
*High-grade / low-grade fever
*Low [[blood pressure]] with normal pulse pressure
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with atrial flutter is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*[[Exophthalmos]] and neck swelling can be seen in [[hyperthyroidism]].
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with atrial flutter is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*[[Rales]] or [[crackles]] may be present.
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===
* Cardiovascular examination of patients with [disease name] is usually normal.
*S3 may be heard in [[congestive heart failure]].
OR
*A mid-to-late [[Systolic click—murmur syndrome|systolic click]] is present, followed by a late [[Systolic murmurs|systolic murmur]] which is best heard at the [[cardiac apex]] is observed in mitral valve prolapse.
*Chest tenderness upon palpation
*[[Holosystolic murmur]] is heard in [[mitral regurgitation]] due to [[rheumatic heart disease]].
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with atrial flutter is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*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 [disease name] is usually normal.
* Back examination of patients with atrial flutter is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Genitourinary]] examination of patients with atrial flutter 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 [disease name] is usually normal.
*[[Neuromuscular]] examination of patients with atrial flutter is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* 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===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Extremities]] examination of patients with atrial flutter is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[CME Category::Cardiology]]


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]

Latest revision as of 18:24, 16 March 2020

Atrial flutter Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial flutter from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

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Acute Treatment of Atrial Flutter
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Physical examination of patients with atrial flutter may reveal tachycardia, hypotension, diaphoresis, and evidence of congestive heart failure. Occasionally, cardiac auscultation may reveal an irregular rhythm, abnormal valve sounds, or a gallop.

Physical Examination

Physical examination of patients with atrial flutter may reveal tachycardia, hypotension, diaphoresis, and evidence of congestive heart failure. Occasionally, cardiac auscultation may reveal an irregular rhythm, abnormal valve sounds, or a gallop.[1][2]

Appearance of the Patient

  • Patients with atrial flutter usually appear normal.

Vital Signs

Skin

  • Skin examination of patients with atrial flutter is usually normal.

HEENT

Neck

  • Neck examination of patients with atrial flutter is usually normal.

Lungs

Heart

Abdomen

  • Abdominal examination of patients with atrial flutter is usually normal.

Back

  • Back examination of patients with atrial flutter is usually normal.

Genitourinary

  • Genitourinary examination of patients with atrial flutter is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with atrial flutter is usually normal.

Extremities

  • Extremities examination of patients with atrial flutter is usually normal.

References

  1. Wills RA (May 1973). "As a factor influencing patron retention". J Am Pharm Assoc. 13 (5): 262–3. doi:10.1016/s0003-0465(16)32574-5. PMID 4698205.
  2. Apgar V (May 1970). "Genetic counseling. Remarks of moderator. Afternoon session". Birth Defects Orig. Artic. Ser. 6 (1): 41. PMID 5522718.

Template:WH Template:WS