Endocarditis physical examination: Difference between revisions

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==Overview==
==Overview==
Common signs on physical examination of endocarditis include [[fever]], presence of a new or changing heart [[murmur]], [[rigors]],  [[Osler's nodes]], [[Janeway lesions]] and evidence of embolization. [[Aortic insufficiency]] with a [[wide pulse pressure]], [[mitral regurgitation]] or [[tricuspid regurgitation]] may be present depending upon the valve that is infected.
Common signs on physical examination of [[endocarditis]] include [[fever]], presence of a new or changing heart [[murmur]], [[rigors]],  [[Osler's nodes]], [[Janeway lesions]] and evidence of [[embolization]]. [[Aortic insufficiency]] with a [[wide pulse pressure]], [[mitral regurgitation]] or [[tricuspid regurgitation]] may be present depending upon the valve that is infected.


==Physical Examination==
==Physical Examination==


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with endocarditis usually appear ill.<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref name="pmid19797553">{{cite journal| author=Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK et al.| title=Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. | journal=J Am Dent Assoc | year= 2009 | volume= 140 | issue= 10 | pages= 1238-44 | pmid=19797553 | doi= | pmc=PMC2770162 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19797553  }} </ref>
*Patients with [[endocarditis]] usually appear ill.<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref name="pmid19797553">{{cite journal| author=Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK et al.| title=Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. | journal=J Am Dent Assoc | year= 2009 | volume= 140 | issue= 10 | pages= 1238-44 | pmid=19797553 | doi= | pmc=PMC2770162 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19797553  }} </ref>


===Vital Signs===
===Vital Signs===
* A [[fever]] will likely be present.
* A [[fever]] will likely be present.
* [[Rigors]] may be present.
* [[Rigors]] may be present.
* Some patients may have a wide [[pulse pressure]] due to [[aortic insufficiency]]. If the pulse pressure narrows, this may be a sign of [[left ventricular failure]] due to earlier closure of the mitral valve and a more rapid rise in the left ventricular end diastolic pressure which will in turn raise the diastolic pressure.
* Some patients may have a wide [[pulse pressure]] due to [[aortic insufficiency]]. If the [[pulse pressure]] narrows, this may be a sign of [[left ventricular failure]] due to earlier closure of the [[mitral valve]] and a more rapid rise in the left [[ventricular]] end [[diastolic pressure]] which will in turn raise the [[diastolic pressure]].


===Skin===
===Skin===
*[[Petechiae]] are present in 10% to 40% of patients
*[[Petechiae]] are present in 10% to 40% of patients
*[[Splinter hemorrhages]] are present in 5% to 15% of patients
*[[Splinter hemorrhages]] are present in 5% to 15% of patients
*[[Osler's nodes]] which are tender subcutaneous nodules in pulp of digits are present in 7% to 10% of patients
*[[Osler's nodes]] which are tender [[subcutaneous]] [[Nodule (medicine)|nodules]] in pulp of [[digits]] are present in 7% to 10% of patients
*[[Janeway lesion]]s which are [[erythema]]tous, nontender lesions on palm or sole are present in 6% to 10% of patients
*[[Janeway lesion]]s which are [[erythema]]tous, nontender [[lesions]] on palm or sole are present in 6% to 10% of patients


{| class="wikitable"
{| class="wikitable"
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===Oral Cavity===
===Oral Cavity===
Examine the oral cavity:
Examine the oral cavity:
* Poor oral hygiene<br>
* Poor oral [[hygiene]]<br>
* [[Teeth]] looking for [[periodontitis]], [[plaque]] and [[calculus]]<BR>
* [[Teeth]] looking for [[periodontitis]], [[plaque]] and [[calculus]]<BR>
* [[Gingiva]] looking for [[gingivitis]]<BR>
* [[Gingiva]] looking for [[gingivitis]]<BR>
* Recent dental procedure
* Recent [[dental]] procedure


*  
*  
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===Neck===
===Neck===


* Neck examination of patients with endocarditis is usually normal.
* Neck examination of patients with [[endocarditis]] is usually normal.


===Lungs===
===Lungs===
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===Abdomen===
===Abdomen===
* [[Abdominal pain]] may be present due to mesenteric embolization or [[ileus]] both of which may manifest as [[reduced bowel sounds]].
* [[Abdominal pain]] may be present due to [[Mesentery|mesenteric]] [[embolization]] or [[ileus]] both of which may manifest as [[reduced bowel sounds]].
* [[Splenomegaly]] may be present in 15% to 30% patients.
* [[Splenomegaly]] may be present in 15% to 30% patients.
* Left upper quadrant pain (LUQ pain) may be present as a result of a [[splenic infarct]] from embolization.
* Left upper quadrant pain (LUQ pain) may be present as a result of a [[splenic infarct]] from [[embolization]].
* [[Flank pain]] may be present as a result of an [[embolus to the kidney]].
* [[Flank pain]] may be present as a result of an [[embolus to the kidney]].



Revision as of 13:34, 4 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Common signs on physical examination of endocarditis include fever, presence of a new or changing heart murmur, rigors, Osler's nodes, Janeway lesions and evidence of embolization. Aortic insufficiency with a wide pulse pressure, mitral regurgitation or tricuspid regurgitation may be present depending upon the valve that is infected.

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Petechiae
Splinter hemorrhages
Osler's nodes
Janeway lesions

Oral Cavity

Examine the oral cavity:

HEENT


Roth's spots (white centered hemorrhage)







Neck

  • Neck examination of patients with endocarditis is usually normal.

Lungs

Heart

Abdomen

Back

  • Back examination of patients with endocarditis is usually normal

Genitourinary

  • Genitourinary examination of patients with endocarditis is usually normal.

Neurologic

Extremities


References

  1. Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)
  2. Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK; et al. (2009). "Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia". J Am Dent Assoc. 140 (10): 1238–44. PMC 2770162. PMID 19797553.


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