Diastolic dysfunction physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]

Overview

In general, signs of both left sided heart failure and right sided heart failure are present. Signs that represent acute left sided failure include cool clammy skin, cyanosis, rales,and a gallop rhythm. Signs that represent right sided failure include an elevated JVP, pedal edema, ascites, hepatomegaly, a parasternal heave and hepatojugular reflux. Commonly signs of both left and right sided failure are present.

Physical Examination

Appearance of the Patient

  • The patient is often sitting upright and there may be labored breathing during an acute episode.
  • The patient's weight should be recorded to ascertain how far they are from their "dry" weight.

Vitals

Pulse

Rate
  • Tachycardia may be present during an episode of acute heart failure

Blood Pressure

  • A narrow pulse pressure (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present.

Respiratory Rate

  • Tachypnea (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure

Skin

Neck

Lungs

  • Pleural effusion with dullness to percussion at the bases may be present in both acute and chronic heart failure
  • Rales is often present in both acute and chronic heart failure

Heart

  • If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.

Auscultation

Abdomen

Extremities

Neurologic

  • Confusion and altered mentation may be present in the setting of acute heart failure

References

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