Post on 30-May-2018
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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)