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    General Examination For CVS

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    studymedic
    General examinations for cardiac patients assess physical signs including development, mental state, evidence of pain or heart failure, color, fingers, and evidence of generalized disease. Signs of heart failure include breathlessness, orthopnea, and lower limb edema. Cyanosis appears as a blue color and can be peripheral or central depending on its location. Clubbing involves soft tissue swelling at the nails and is associated with lung and heart conditions. Edema is swelling usually in the lower limbs and is caused by heart failure, immobility, or reduced protein levels.

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    General Examination For CVS

    Uploaded by

    studymedic
    490 views29 pages
    General examinations for cardiac patients assess physical signs including development, mental state, evidence of pain or heart failure, color, fingers, and evidence of generalized disease. Signs of heart failure include breathlessness, orthopnea, and lower limb edema. Cyanosis appears as a blue color and can be peripheral or central depending on its location. Clubbing involves soft tissue swelling at the nails and is associated with lung and heart conditions. Edema is swelling usually in the lower limbs and is caused by heart failure, immobility, or reduced protein levels.

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    General Examination for CVS

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    General examinations for cardiac patients assess physical signs including development, mental state, evidence of pain or heart failure, color, fingers, and evidence of generalized disease. Signs of heart failure include breathlessness, orthopnea, and lower limb edema. Cyanosis appears as a blue color and can be peripheral or central depending on its location. Clubbing involves soft tissue swelling at the nails and is associated with lung and heart conditions. Edema is swelling usually in the lower limbs and is caused by heart failure, immobility, or reduced protein levels.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    490 views29 pages

    General Examination For CVS

    Uploaded by

    studymedic
    General examinations for cardiac patients assess physical signs including development, mental state, evidence of pain or heart failure, color, fingers, and evidence of generalized disease. Signs of heart failure include breathlessness, orthopnea, and lower limb edema. Cyanosis appears as a blue color and can be peripheral or central depending on its location. Clubbing involves soft tissue swelling at the nails and is associated with lung and heart conditions. Edema is swelling usually in the lower limbs and is caused by heart failure, immobility, or reduced protein levels.

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    of 29

    General Examination for

    CVS

    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.
    General appearance:
    1. Physical development
    2. Mental changes
    3. Evidence of pain
    4. Evidence of heart failure
    5. Color (complexion) of the patient
    6. Fingers
    7. Evidence of generalized disease
    8. Vital signs
    1. Physical development:

    • somatic infantilism: retarded


    physical and mental growth in severe
    cardiac diseases starting in childhood

    • cachexia in advanced heart failure


    2. Mental changes:

    • depression: following myocardial


    infarction

    • Restlessness, lack of concentration,


    lethargy or confusion due to hypoxia,
    electrolyte imbalance or cerebral
    atherosclerosis
    3. Evidence of pain:

    • myocardial infarction: patient looks


    distressed, may be pale, cold and
    sweaty

    • pericarditis: patient is
    uncomfortable, prefers to sit up and
    lean forward , respiration is painful.
    4. evidence of heart failure:
    • breathlessness and
    orthopnea in left
    sided heart failure

    • Lower limb oedema


    in right sided heart Orthopnea
    failure
    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 by
    tricuspid regurge
    • Jaundice: cardiac cirrhosis - pulmonary
    infarction
    Mitral Cyanosis
    facies
    6. Fingers:
    • Clubbing: infective
    endocarditis -
    congenital cyanotic
    heart diseases

    • splinter
    haemorrhages:
    infective
    endocarditis
    7. Evidence of generalized
    disease:
    • Thyrotoxicosis
    • Myxoedema
    • Acromegaly
    • Stigmata of hyperlipidaemia: xanthelasma
    and corneal arcus
    8. Vital signs:

    • temperature
    • Pulse
    • blood pressure
    • Respiratory rate
    Cyanosis

    Definition:

    Bluish discoloration of the skin and


    mucous membranes due to increased
    amounts of reduced haemoglobin.
    Cyanosis manifests when the absolute
    concentration of reduced haemoglobin
    exceeds 5 g/dl, therefore it may be absent
    in anaemia despite severe hypoxaemia
    and it’s easily detected in ploycythaemia.

    If cyanosis is just seen in the nails, tips of


    nose it is called peripheral cyanosis,
    whereas if seen in the tongue, lips and
    nails it is central cyanosis.
    Peripheral cyanosis:

    It is usually due to increased oxygen


    extraction with a slow moving circulation.
    It is seen in cold weather, Raynaud's
    phenomenon or peripheral vascular
    diseases.
    Causes of central cyanosis:
    Acute:

    • severe pneumonia

    • acute bronchial asthma

    • pulmonary oedema

    • pulmonary embolism
    Chronic:

    • severe chronic airflow obstruction

    • pulmonary fibrosis

    • right to left cardiac shunt


    Clubbing
    It 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 flow
    through the fingers. Vagotomy can abolish
    clubbing
    Signs of clubbing:
    • 1. increased sponginess of the nail bed
    with increase in the angle between it and
    the nail usually more than 180°

    • 2. Increased curvature of nails in both


    longitudinal and lateral axes (beaking)

    • 3. Increased bulk of soft tissues over the


    terminal phalanges giving a drum-stick
    appearance
    Signs of clubbing
    (contd):
    4. Hypertrophic pulmonary
    osteoarthropathy:
    pain and swelling over the beds of the
    long bones above the wrists and
    ankles symmetrically due to
    subperiosteal new bone formation. It is
    usually associated with squamous cell
    carcinoma of the lung
    Detection of clubbing

    Normal Clubbing
    Causes of clubbing:
    Cardiac:

    • infective endocarditis

    • cyanotic congenital heart diseases


    Pulmonary:

    • Bronchial carcinoma
    • Fibrosing alveolitis
    • Lung abscess
    • Bronchiactesis
    • Empyema
    Gastrointesinal:

    • Ulcerative colitis

    • Crohn's disease

    • Liver cirrhosis
    Peripheral oedema
    Definition 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.
    Causes:
    Unilateral:

    • Deep vein
    thrombosis
    • soft tissue infection
    • trauma
    • immobility (e.g. Deep vein
    hemiplegia) thrombosis
    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)
    Soft pitting
    oedema
    Filariasis Lymphatic obstruction
    following mastectomy
    • Drugs: NSAIDs, corticosteroids, calcium
    channel blockers (e.g. nifedipine)

    • Inferior vena caval obstruction

    • Immobility

    • Thiamine deficiency (wet beri beri)

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