Cyanotic Heart Disease - Eisenmenger's (Pulmonary HTN + features of VSD/ASD/PDA)

 

Thank you for asking me to perform a cardiovascular of examine Mr. X, who presented with SOB.

 

The salient findings on examination were central cyanosis, finger clubbing and clinical signs of pulmonary hypertension, suggestive of Eisenmenger’s syndrome.

• The presence of a single second heart sound suggests a VSD

• The presence of a wide fixed splitting secondary heart sound suggests an ASD

• The normal/reversed S2 suggests a PDA

 

I will now present my findings in full before commenting on differentials, aetiology, severity and complications.

 

The patient was comfortable at rest with normal/increased WOB. There was central cyanosis.

 

On examination of the hands, there clubbing and peripheral cyanosis.

 

The pulse was ____ and regular/irregular (if irregular, consistent with atrial fibrillation).

 

The blood pressure was ____.

 

On examination of the face, there was no scleral icterus, conjunctival pallor, or xanthelasma. There was central cyanosis. Dentition was adequate/inadequate.

 

The JVP was/was not elevated at ___ cm above the sternal notch with normal prominent A-waves (prominent A-waves if pulmonary hypertension).

 

The carotid pulse was normal character in character.

 

On inspection of the praecordium, there were/were not scars and nil obvious deformity.

 

On palpation, the apex beat was fifth intercostal space mid-clavicular line (presumably not volume or pressure loaded unless left ventricular involved). There were/were not any palpable thrills (may have thrill for TR). There was a palpable P2. There was a left parasternal heave.

 

On auscultation:

• Murmur of TR and PR if functional secondary to pulmonary hypertension

 

There was a:

• Single second heart sound, suggestive of underlying VSD

• A fixed secondary heart sound, suggesting of ASD

 

On further examination, there was/was not evidence of left and right heart decompensation with sacral oedema or peripheral oedema, and vesicular breath sounds/bibasal inspiratory crackles. There was/was not a pulsatile liver, and nil gross ascites.

 

In summary, the constellation of central cyanosis, finger clubbing and signs of pulmonary hypertension suggest Eisenmenger’s syndrome.

• The presence of a single second heart sound suggests a VSD

• The presence of a wide fixed splitting secondary heart sound suggests an ASD

• The normal/reversed SR suggests a PDA

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