Long QT syndrome physical examination: Difference between revisions

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{{Long QT Syndrome}}
{{Long QT Syndrome}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}}Farima Kahe


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with long QT syndrome is usually remarkable for hearing loss in Jervell and Lang-Nielsen (JLN) syndrome. Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.
 
OR
 
Common physical examination findings of [disease name] include [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].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with long QT syndrome is usually remarkable for hearing loss in Jervell and Lang-Nielsen (JLN) syndrome. Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.
 
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 long QT syndrome usually appear normal.


===Vital Signs===
===Vital Signs===
 
*[[Bradyycardia|Bradycardia]] with regular pulse due to aging may be seen.
*High-grade / low-grade fever
*[[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 long QT syndrome 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.
* Hearing loss (congenital deafness), may be seen in Jervell and Lang-Nielsen (JLN) syndrome.<ref name="pmid18606002">{{cite journal |vauthors=Crotti L, Celano G, Dagradi F, Schwartz PJ |title=Congenital long QT syndrome |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=18 |date=July 2008 |pmid=18606002 |pmc=2474834 |doi=10.1186/1750-1172-3-18 |url=}}</ref>
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 long QT syndrome 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.
* Pulmonary examination of patients with Long QT syndrome is usually normal.
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.
*Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.<ref name="pmid22830134">{{cite journal |vauthors=Niaz A, Rizvi SF, Khurram D |title=Prevalence of long QT syndrome and other cardiac defects in deaf-mute children |journal=J Ayub Med Coll Abbottabad |volume=23 |issue=1 |pages=5–8 |date=2011 |pmid=22830134 |doi= |url=}}</ref>
OR
*Chest tenderness upon palpation
*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 long QT syndrome 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.
* Scoliosis may be seen in LQT7 (Andersen syndrome).
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 long QT syndrome 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 long QT syndrome 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.
* Short stature may be seen in LQT7 (Andersen syndrome).<ref name="pmid20301441">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, Veerapandiyan A, Statland JM, Tawil R |title= |journal= |volume= |issue= |pages= |date= |pmid=20301441 |doi= |url=}}</ref>
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 19:17, 6 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Farima Kahe

Overview

Physical examination of patients with long QT syndrome is usually remarkable for hearing loss in Jervell and Lang-Nielsen (JLN) syndrome. Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.

Physical Examination

Physical examination of patients with long QT syndrome is usually remarkable for hearing loss in Jervell and Lang-Nielsen (JLN) syndrome. Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.

Appearance of the Patient

  • Patients with long QT syndrome usually appear normal.

Vital Signs

  • Bradycardia with regular pulse due to aging may be seen.

Skin

  • Skin examination of patients with long QT syndrome is usually normal.

HEENT

  • Hearing loss (congenital deafness), may be seen in Jervell and Lang-Nielsen (JLN) syndrome.[1]

Neck

  • Neck examination of patients with long QT syndrome is usually normal.

Lungs

  • Pulmonary examination of patients with Long QT syndrome is usually normal.

Heart

  • Heart murmur due to hypertrophic cardiomyopathy or valvular defect may be heard.[2]

Abdomen

  • Abdominal examination of patients with long QT syndrome is usually normal.

Back

  • Scoliosis may be seen in LQT7 (Andersen syndrome).

Genitourinary

  • Genitourinary examination of patients with long QT syndrome is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with long QT syndrome is usually normal.

Extremities

  • Short stature may be seen in LQT7 (Andersen syndrome).[3]

References

  1. ↑ Crotti L, Celano G, Dagradi F, Schwartz PJ (July 2008). "Congenital long QT syndrome". Orphanet J Rare Dis. 3: 18. doi:10.1186/1750-1172-3-18. PMC 2474834. PMID 18606002.
  2. ↑ Niaz A, Rizvi SF, Khurram D (2011). "Prevalence of long QT syndrome and other cardiac defects in deaf-mute children". J Ayub Med Coll Abbottabad. 23 (1): 5–8. PMID 22830134.
  3. ↑ Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean L, Stephens K, Amemiya A, Veerapandiyan A, Statland JM, Tawil R. PMID 20301441. Vancouver style error: initials (help); Missing or empty |title= (help)

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