Cardiac disease in pregnancy physical examination

Overview
Significant similarities exist between the normal signs of pregnancy and the presence of an underlying cardiac disease; hence poses a clinical challenge to differentiate between the two. However, common signs include: jugular venous distension, pulmonary rales, increased intensity of heart sounds and pedal edema.

Vitals

 * Arterial pulses are high volume and collapsing in nature. Such collapsing pulse must be differentiated from other hyperdynamic states including aortic insufficiency and hyperthyroidism.

Neck

 * Jugular venous distension may be present

Lungs

 * Adventitious sounds such as basal rales may be appreciated

Heart Sounds:

 * Increased intensity of the first heart sound secondary to physiologic hyperdynamic circulation during pregnancy
 * Persistent split S2
 * Third heart sound is uncommon

Murmur:

 * Pulmonic midsystolic murmur
 * Continuous murmur (mammary soufflé, cervical hum)
 * In general there are often innocent murmurs of pregnancy. These are the result of a hyperkinetic circulation. These murmurs are usually midsystolic and soft and heard best at the left lower sternal border and over the pulmonic area.

Extremities

 * Varicosities and ankle edema secondary to inferior vena caval compression