Office of Education
Yale University
School of Medicine
367 Cedar Street
300 ESH
New Haven, CT
06519 USA

Cases | Cardiothoracic | Kugel

Elsie Kugel: Physical Examination

Vital signs

Temp 98 degrees; pulse 90 and regular; BP 180/98, weight 150 pounds.

HEENT

Normal.

Neck

Normal; no thyromegaly; jugular veins distended at 60 degrees.

Chest

Rales at both bases, no egophony.

Heart

Regular; apical impulse visible and PMI palpable in the 6th ICS, 2 cm to the left of the MCL; S1 and S2 normal, S3 gallop present; 2/6 systolic ejection murmur at the apex and lower left sternal border.

Abdomen

Soft and non-tender; no organomegaly or mass.

Extremities

2 plus pretibial edema.

Skin

Normal.

Self-assessment question:

Which of the following findings indicate ventricular dysfunction?

a. PMI displaced to the left
b. Systolic murmur
c. S3 gallop

The correct answer is c. The S3 gallop is a result of early diastolic filling of a non-compliant ventricle. Displacement of the PMI indicates cardiac enlargement and the murmur indicates valve dysfunction.

Next: Test results

YSMInfo     Library     Calendar     Directories     Search     YSM Home

Last modified: Thursday, 01-Aug-2002 16:45:20 EDT. (PL)

Copyright ©2001 Yale University School of Medicine. All rights reserved.

Comments or suggestions to the site editor.

Home URL: http://info.med.yale.edu/casebook