Total anomalous pulmonary venous connection physical examination

The physical findings depend on the degree of obstruction and the degree of left-to-right shunting. Physical examination of patients may be remarkable for a decreased pulse, hypotension, tachypnea, peripheral edema, S3 gallop, diastolic murmur due to tricuspid regurgitation, hepatomegaly, and cyanosis.

The physical examination in patients with total anomalous pulmonary venous connection depends on the following factors:^[1][2]

• Type of anatomic connection present between systemic and pulmonary venous circulation
• Degree of obstruction
• Type of obstruction (obstructed, unobstructed)
• Amount of right to left shunting

• Decreased pulses (low systemic blood flow)

• Hypotension (low systemic blood flow)

• Tachypnea (right sided volume overload)
• Peripheral edema (right sided heart failure)

• Cardiovascular examination of patients with total anomalous pulmonary venous connection may be remarkable for:

• Precodial asymmetry indicating right ventricular hypertrophy may be present.

• Right ventricular heave or lift may be present.

• Prominent, fixed split second heart sound (S2) is present.
• S3 gallop may be present.

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• Systolic ejection murmur due to increased stroke volume across the pulmonary valve best heard at the left upper sternal border may be present. Ejection murmurs are more prominent in unobstructed TAPVC.
• Diastolic murmur due to tricuspid regurgitation may be present.

• Hepatomegaly

• Cyanosis (right to left shunt)

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