Diastolic dysfunction physical examination

In general, signs of both left sided heart failure and right sided heart failure are present. Signs that represent acute left sided failure include cool clammy skin, cyanosis, rales and a gallop rhythm. Signs that represent right sided failure include an elevated JVP, pedal edema, ascites, hepatomegaly, a parasternal heave and hepatojugular reflux.

• The patient is often sitting upright and there may be labored breathing during an acute episode
• The patient’s weight should be recorded to ascertain how far they are from their “dry” weight

• Tachycardia may be present during an episode of acute heart failure

• A narrow pulse pressure (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present

• Tachypnea (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure

• The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock may be present during an episode of acute heart failure
• Cyanosis is observed if severe hypoxemia is present during an episode of acute heart failure
• Anasarca may be present due to chronic heart failure

• Jugular vein distention is often present in both acute and chronic heart failure
• Central venous pressure > 16 cmH₂O is often present in both acute and chronic heart failure

• Pleural effusion with dullness to percussion at the bases may be present in both acute and chronic heart failure
• Rales is often present in both acute and chronic heart failure

• If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.

• S3 and a gallop rhythm
• Underlying valvular causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated

• Hepatojugular reflux
• Hepatomegaly may be present as a result of chronic heart failure
• Ascites may be present as a result of chronic heart failure

• Bilateral ankle edema may be present as a result of chronic heart failure

• Confusion and altered mentation may be present in the setting of acute heart failure

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