Page 150 - Clinical Pearls in Cardiology

138 Clinical Pearls in Cardiology

• Left-sided tumors may obstruct the mitral valve and
cause physical findings mimicking mitral stenosis.
Episodic pulmonary edema, classically occurring
when an upright posture is assumed can occur.
• Right-sided myxomas may cause symptoms of right-
sided heart failure.
18. What are the abdominal findings that you should
carefully look for while examining a patient with heart
disease?
The important physical findings in the abdomen that
have to be carefully looked for while examining a patient
with heart disease are the following:
• Hepatomegaly: Passive congestion of the liver in heart
failure leads to firm, tender hepatomegaly, which in
later stages, may progress to cardiac cirrhosis.
• Hepatic pulsations are appreciated by bimanual
palpation of the liver. Systolic pulsations are seen in
tricuspid regurgitation and aortic regurgitation. Pre-
systolic pulsations are seen in tricuspid stenosis
(Fig. 1).
• Splenomegaly: In infective endocarditis and
congestive heart failure.

Fig. 1: Examining hepatic pulsations