Intraventricular conduction delay physical examination

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

Physical examination should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. Jugular pulsation may be noted in the neck exam.

Bradycardia and tachycardia may help to correlate the pathophysiology of IVCD ECG pattern and variation in pulse like pulsus paradoxus help in finding the underlying heart disease. Pulse rhythm may get affected if an IVCD progress to ventricular tachycardia or complete heart block.

• Hemodynamic compromise (hypotension, shock) can be a cause or an complicating symptom.
• Highly inconsistent fluctuations in the blood pressure can occur because of the variability in the degree of left atrial (LA) contribution to LV filling, stroke volume, and cardiac output.

• Intermittent cannon A waves can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction.

• Variability in the occurrence and intensity of heart sounds (especially S1) may also be observed and is heard more frequently when the rate of the tachycardia is slower.
• On examination of the cardiovascular system, a paradoxical split of the second heart sound may be heard in BBB.
• Atrioventricular dissociation if present will result in variable intensity of the first heart sound secondary to a changing PR interval.
• Look for evidence of preexisting conditions like a pacemaker/AICD or scar mark from previous cardiothoracic surgery.

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