Fibromuscular dysplasia physical examination
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ASA/ACCF/AHA Guideline Recommendations
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Patients with FMD usually appear normal. In physical examination of patients with FMD mild to moderate hypertension may be detected. In the auscultation of neck among patients with involvement of carotid artery or auscultation of epigastric or flank of renovascular FMD bruits may be heard. Eventullay due to nonspecific sypmtoms and sings of FMD, the diagnosis of this disease needs highly clinical suspicion of healthcare provider.
- Physical examination of patients with fibromuscular dysplasia is usually normal. However the most common presentation of renal artery FMD is renovascular hypertension, but in the physical examination of patients enrolled in the US registry for fibromuscular dysplasia mean blood pressure was 130/75 mm Hg.
- The presence of carotid bruits on physical examination has low sensitivity however its specificity for identifying extracranial FMD is highly suggestive.
- The presence of an epigastric or flank bruit on physical examination, such as carotid bruits is low, however, its presence strongly suggestive of renal or mesenteric FMD.
- Focal neurological deficits, cranial nerve involvement, pupil abnormality or ptosis (findings consistent with Horner syndrome) may be detected in FMD.
Appearance of the Patient
- Patients with FMD usually appear normal.
- High blood pressure may be seen among patients with renovascular FMD.
- Skin examination of patients with FMD is normal.
- HEENT examination of patients with FMD is normal.
- Carotid bruits may be auscultated unilaterally or bilaterally using the bell of the stethoscope.
- In abdominal examination of patients with FMD, epigastric or flank bruits may be heard.
- While FMD involving the lower extremities most commonly involves the external iliac arteries, extremities examination of patients with FMD is usually normal, however, a bruit caused by iliac FMD may be heard in the lower abdomen from the umbilicus to the inguinal region.
- FMD involving the upper extremities most commonly involves the brachial arteries, in some cases, there may be discrepant blood pressures in the arms. Arm claudication or a bruit heard over the antecubital fossa is uncommon but may occur.
- Jeffrey W. Olin, James Froehlich, Xiaokui Gu, J. Michael Bacharach, Kim Eagle, Bruce H. Gray, Michael R. Jaff, Esther S. H. Kim, Pam Mace, Alan H. Matsumoto, Robert D. McBane, Eva Kline-Rogers, Christopher J. White & Heather L. Gornik (2012). "The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients". Circulation. 125 (25): 3182–3190. PMID 22615343. doi:10.1161/CIRCULATIONAHA.112.091223.
- Jeffrey W. Olin, Heather L. Gornik, J. Michael Bacharach, Jose Biller, Lawrence J. Fine, Bruce H. Gray, William A. Gray, Rishi Gupta, Naomi M. Hamburg, Barry T. Katzen, Robert A. Lookstein, Alan B. Lumsden, Jane W. Newburger, Tatjana Rundek, C. John Sperati & James C. Stanley (2014). "Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association". Circulation. 129 (9): 1048–1078. PMID 24548843. doi:10.1161/01.cir.0000442577.96802.8c.