During the evaluation of patients with suspected severe cardiovascular pathology, astute bedside physical examination can often differentiate between underlying etiologies. Match the following advanced eponymous physical examination findings with the specific pathophysiologic mechanism that produces them.
- Ewart sign (dullness to percussion, bronchial breath sounds, and egophony at the angle of the left scapula)Large accumulation of fluid in the pericardial sac causing compressive atelectasis of the adjacent lung tissue.
- Kussmaul sign (paradoxical increase in jugular venous distention during inspiration)Impaired ability of the right heart to accommodate the normal inspiratory increase in systemic venous return.
- Friedreich sign (exaggerated, precipitous 'y' descent on the jugular venous waveform)Rapid, uninhibited early diastolic ventricular filling that is abruptly halted by an inelastic, scarred pericardial sac.
- Ortner syndrome finding (new-onset hoarseness in a patient with an apical mid-diastolic rumble)Massive left atrial enlargement causing traction and compression of the left recurrent laryngeal nerve.
- Traube sign ("pistol shot" booming systolic sounds auscultated over the femoral arteries)Extremely wide pulse pressure causing rapid systolic vascular expansion and rapid diastolic peripheral runoff.
Answer
Ewart sign matches to pericardial effusion with lung compression. Kussmaul sign matches to the inability of the right heart to accommodate venous return. Friedreich sign matches to rapid diastolic filling restricted by a stiff pericardium. Ortner syndrome matches to left atrial enlargement compressing the recurrent laryngeal nerve. Traube sign matches to wide pulse pressure with rapid vascular expansion.
Each physical sign represents a distinct hemodynamic consequence of severe cardiovascular disease. Ewart sign is a pulmonary finding caused by a massive pericardial effusion compressing the lung base. Kussmaul sign indicates right-sided heart failure (often constrictive pericarditis or right ventricular infarction) where the right ventricle cannot accommodate normal inspiratory venous return. Friedreich sign (prominent 'y' descent) is the hallmark of constrictive pericarditis, representing rapid early filling abruptly halted by a stiff pericardium. Ortner syndrome occurs when severe mitral stenosis causes massive left atrial dilation, compressing the left recurrent laryngeal nerve against the aortic arch. Traube sign is an arterial manifestation of the hyperdynamic circulation and wide pulse pressure seen in severe aortic regurgitation.
Step-by-Step Solution
Key Concept
Pathophysiology of Advanced Cardiovascular Physical Examination Findings
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