Patent ductus arteriosus physical examination

Jump to: navigation, search

Patent Ductus Arteriosus Microchapters

Home

Patient Information

Diagram

Overview

Anatomy

Historical Perspective

Pathophysiology

Causes

Differentiating Patent Ductus Arteriosus from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Other Imaging Findings

Treatment

Medical Therapy

Preterm Infants
Term and Older Children

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Patent ductus arteriosus physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Patent ductus arteriosus physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Patent ductus arteriosus physical examination

CDC on Patent ductus arteriosus physical examination

Patent ductus arteriosus physical examination in the news

Blogs on Patent ductus arteriosus physical examination

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Patent ductus arteriosus physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3], Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Physical Examination

Vital Signs

Pulse

Blood Pressure

Heart

Small PDA

Moderate PDA

  • Pulmonary to systemic flow ratio between 1.5 and 2.2 to 1
  • As a result of the runoff from the aorta, there are bounding pulses, and the pulse pressure widens.
  • A continuous thrill may be present in the first or second left intercostal space.
  • Displaced apex (indicating left ventricular overload)
  • Continuous murmur (may be grade 2,3 and occasionally 4)
  • The features of murmur are very similar to that seen with small ducts, however, they are louder than that associated with small PDA.

Large PDA

  • Pulmonary to systemic flow ratio >2.2 to 1
  • Dynamic left ventricular impulse
  • Left ventricular thrill
  • S1 is normal, S2 may be split with an accentuated pulmonary component. The continuous machinery murmurs with similar features as seen in moderate and small sized ducts but with louder intensity (4/6 grade) could be heard.
  • An apical diastolic rumble due to increased flow across the mitral valve may be present.
  • A third heart sound may be present.
  • If there is no reduction in the size of ductus, after age 2, progressive obstructive disease develops in these patients:
    • Signs of heart failure develop
    • The JVP may be elevated due to RV failure. Prominent "a wave" due to diminished RV compliance and RVH.
    • Signs of pulmonary hypertension associated with right-to-left shunt start appearing.
    • As the pulmonary hypertension increases, left to right flow across the duct decreases and there is no audible murmur. A murmur of pulmonic insufficiency may be noted (Graham-Steell murmur) due to dilation of the pulmonic valve ring resulting from pulmonary hypertension. Flow into a dilated pulmonary trunk causes a pulmonic ejection sound and pulmonic ejection murmur. The second pulmonic heart sound is closely split or not split.

Extremities

References


Linked-in.jpg