Alcoholic cardiomyopathy physical examination

Patients with alcoholic cardiomyopathy present with signs similar to that of heart failure. Most common findings include pedal edema, increased jugular venous pressure, pulmonary edema, and abnormal heart sounds.

The patient may have altered mental status due to chronic alcoholism.

• Hypertension may be present.

• Jugular venous distension may be seen in the presence of right heart failure.

• Pedal edema
• Cold extremities with decreased pulse

• Rales may be heard on lung exam due to pulmonary congestion.

• Enlargment of the heart with a laterally displaced and diffused point of maximal impulse.

• Abnormal heart sounds, namely third S3 and fourth S4 sounds may be heard.
• Apical murmur of mitral regurgitation and the lower parasternal murmur of tricuspid regurgitation may be present secondary to papillary muscle displacement and dysfunction.

• Hepatomegaly
• Ascites

Other sequelae of alcoholic liver disease may also be noted on physical examination.

• Telangiectasia
• Spider angiomata

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