general examination for cvs

8/14/2019 General Examination for CVS

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General Examination forCVS

Physical signs:

These are the manifestations that the doctor finds during

examination. Certain abnormalities in the general examination

may help in the diagnosis and assessment of a cardiac

patient.


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General appearance:

1. Physical development2. Mental changes

3. Evidence of pain4. Evidence of heart failure5. Color (complexion) of the patient

6. Fingers7. Evidence of generalized disease8. Vital signs


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1. Physical development:

somatic infantilism: retardedphysical and mental growth in severecardiac diseases starting in childhood

cachexia in advanced heart failure


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2. Mental changes:

depression: following myocardialinfarction

Restlessness, lack of concentration,lethargy or confusion due to hypoxia,

electrolyte imbalance or cerebralatherosclerosis


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3. Evidence of pain:

myocardial infarction: patient looksdistressed, may be pale, cold and

sweaty

pericarditis: patient isuncomfortable, prefers to sit up andlean forward , respiration is painful.


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4. evidence of heart failure:

breathlessness andorthopnea in left

sided heart failure

Lower limb oedemain right sided heartfailure Orthopnea


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5. Complexion:

Pallor: anemia - Heart failure

Malar flush: mitral stenosis

cyanosis: pulmonary oedema - right to left

shunt Plethora: polycythaemia - Cushing's disease

- alcohol abusers

Pigmentation (brownish): long standing

cases with right heart failure complicated bytricuspid regurge

Jaundice: cardiac cirrhosis - pulmonaryinfarction


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Mitralfacies

Cyanosis


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6. Fingers:

Clubbing: infectiveendocarditis -

congenital cyanoticheart diseases

splinterhaemorrhages:infectiveendocarditis


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7. Evidence of generalized

disease: Thyrotoxicosis

Myxoedema

Acromegaly Stigmata of hyperlipidaemia: xanthelasma

and corneal arcus


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8. Vital signs:

temperature

Pulse

blood pressure

Respiratory rate


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Cyanosis

Definition:

Bluish discoloration of the skin and

mucous membranes due to increased

amounts of reduced haemoglobin.


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Cyanosis manifests when the absoluteconcentration of reduced haemoglobinexceeds 5 g/dl, therefore it may be absentin anaemia despite severe hypoxaemia

and its easily detected in ploycythaemia.

If cyanosis is just seen in the nails, tips ofnose it is called peripheral cyanosis,whereas if seen in the tongue, lips andnails it is central cyanosis.


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Peripheral cyanosis:

It is usually due to increased oxygenextraction with a slow moving circulation.

It is seen in cold weather, Raynaud'sphenomenon or peripheral vasculardiseases.


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Causes of central cyanosis:

Acute:

severe pneumonia

acute bronchial asthma

pulmonary oedema

pulmonary embolism


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Chronic:

severe chronic airflow obstruction

pulmonary fibrosis

right to left cardiac shunt


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ClubbingIt is caused by connective tissue proliferation

leading to increase in the soft tissue at the base

of the nails

Pathogenesis is unclear, may be neurogenic or

hormonal. There is an increased blood flowthrough the fingers. Vagotomy can abolish

clubbing


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Signs of clubbing:

1. increased sponginess of the nail bedwith increase in the angle between it andthe nail usually more than 180

2. Increased curvature of nails in bothlongitudinal and lateral axes (beaking)

3. Increased bulk of soft tissues over theterminal phalanges giving a drum-stickappearance


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Signs of clubbing(contd):

4. Hypertrophic pulmonaryosteoarthropathy:

pain and swelling over the beds of thelong bones above the wrists andankles symmetrically due to

subperiosteal new bone formation. It isusually associated with squamous cellcarcinoma of the lung


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Detection of clubbing

Normal Clubbing


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Causes of clubbing:

Cardiac:

infective endocarditis

cyanotic congenital heart diseases


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Pulmonary:

Bronchial carcinoma

Fibrosing alveolitis

Lung abscess

Bronchiactesis

Empyema


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Gastrointesinal:

Ulcerative colitis

Crohn's disease

Liver cirrhosis


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Peripheral oedemaDefinition of oedema:

swelling of tissues due to an increase in the

interstitial fluid.

When the pressure in the capillaries exceeds the

osmotic pressure of the blood, fluid will leak out of the

circulation into the interstitial space.

Oedema is usually found in the lower limbs,

especially over ankles, or over the sacrum in patients

lying in bed.


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Causes:

Unilateral:

Deep veinthrombosis

soft tissue infection

trauma immobility (e.g.

hemiplegia)

Deep veinthrombosis


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Bilateral:

Heart failure

Chronic venous insufficiency

Hypoproteinaemia e.g. nephrotic syndrome -cirrhosis - malnutrition (soft pitting oedema)

Lymphatic obstruction: e.g. pelvic tumour,Filariasis ( hard non-pitting oedema)


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Soft pittingoedema


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Filariasis Lymphatic obstructionfollowing mastectomy


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Drugs: NSAIDs, corticosteroids, calciumchannel blockers (e.g. nifedipine)

Inferior vena caval obstruction

Immobility

Thiamine deficiency (wet beri beri)

general examination for cvs

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