Utility of a Sticky Note “Post-it” and a Cotton Swab as a Tool to Aid Cardiac Examination.
On examination, the patient was in respiratory distress with tachypnea. The temperature was 37.1 ºC, the pulse 86 beats per minute, respiratory rate 32 breaths per minute, and the blood pressure 120/80 mmHg. Examination of the neck demonstrated the jugular venous pressure of 10 cm of water, and examination of the chest revealed limited movement of the chest due to deformities of thoracic spine and rib cage, which was consistent with the known diagnosis of severe kyphoscoliosis.
Arterial blood gas analysis revealed worsening hypoxemia compared with her baseline: pH 7.379, pCO2 57 mmHg, pO2 54.6 mmHg, HCO3-32.9 mEq/L, and oxygen saturation (SpO2) 85% while she was breathing with supplemental oxygen of 0.5 L/min via nasal cannula. Electorocardiogram (ECG) showed a pulmonary p wave, tall R wave in V1, deep S wave in V5/V6, and right axis deviation (Figure 3), suggesting right ventricular hypertrophy.
On further examination, auscultation of the heart revealed accentuated pulmonary component (P2) of the second heart sound (S2) together with parasternal heave. The parasternal heave was also clearly visualized by attaching a “Post-it” at the second parasternal left intercostal space (LICS) and the third LICS in both supine (Video 4) and sitting position (Video5).
Echocardiography confirmed the presence of right heart failure by enlargement of right ventricle and elevated estimated pulmonary artery systolic pressure of 69 mmHg calculated from
tricuspid regurgitation (TR) velocity. These inexpensive bedside tools enable us to diagnose heart
failure at the bedside more easily and quickly, as seen in our case, even prior to the application of echocardiography to further facilitate the treatment
Pulm Res Respir Med Open J. 2016; SE(1): S17-S19.doi: 10.17140/PRRMOJ-SE-1-106