Dilated cardiomyopathy physical examination

Patients with dilated cardiomyopathy (DCM) usually appear lethargic and may display the general appearance of heart failure. Physical examination of patients with DCM is usually remarkable for cardiac examination findings (lateral displacement of the point of maximal impulse, right ventricular heave, S₂ at the base, and S3 gallops), jugular venous distension, and peripheral edema.

The physical examination of patients with dilated cardiomyopathy may show:^[1][2][3][4]

• Patients with DCM usually appear lethargic and may display the general appearance of heart failure.

• Tachycardia with regular or irregular pulse (in case of atrial fibrillation)
• Tachypnea
• Weak pulse (low pulse pressure)
• Low blood pressure may be present

• Cyanosis
• Pallor in case of heart failure.

• HEENT examination of patients with DCM is usually normal

• Jugular venous distension

• Fine crackles upon auscultation of the lung bases bilaterally

• Lateral displacement of the point of maximal impulse (PMI)
• Right ventricular heave
• S₂ at the base (paradoxical splitting, prominent P₂)
• S3 Gallops
• Atrial fibrillation may be present

• Hepatomegaly in heart failure

• Back examination of patients with DCM is usually normal

• Genitourinary examination of patients with DCM is usually normal.

• Neuromuscular examination of patients with DCM is usually normal

• Cyanosis
• Clubbing
• Pitting edema of the upper/lower extremities in heart failure

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