Heart physical exam

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Heart physical exam
2013-04-09 05:42:34

Heart physical exam
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  1. Central cyanosis
    significant right-to-left shunting at the level of the heart or lungs
  2. Peripheral cyanosis or acrocyanosis
    • reduced extremity blood flow due to small vessel constriction, as seen in
    • patients with severe heart failure, shock, or peripheral vascular disease
  3. Differential cyanosis
    • isolated cyanosis affecting the lower but not the upper extremities in a patient
    • with a large patent ductus arteriosus (PDA) and secondary pulmonary hypertension
    • with right-to-left to shunting at the great vessel level
  4. Malar telangiectasia
    are seen in patients with advanced mitral stenosis and scleroderma
  5. Hereditary telangiectasias on the lips, tongue, and mucous membranes
    • as part of the Osler-Weber-Rendu syndrome (hereditary hemorrhagic
    • telangiectasia), resemble spider nevi and can be a source of right-to-left
    • shunting when also present in the lung
  6. tan or bronze discoloration of the skin
    • may suggest hemochromatosis as the cause of the associated systolic heart
    • failure
  7. eruptive xanthomatosis and lipemia retinalis
    Severe hypertriglyceridemia
  8. Palmar crease xanthomas
    are specific for type III hyperlipoproteinemia
  9. Pseudoxanthoma elasticum
    • a disease associated with premature atherosclerosis, is manifested by a
    • leathery, cobblestoned appearance of the skin in the axilla and neck creases and
    • by angioid streaks on funduscopic examination
  10. Extensive lentiginoses
    • have been described in a variety of development delay–cardiovascular syndromes,
    • including Carney syndrome, which includes multiple atrial myxomas
  11. lupus pernio and erythema nodosum
    • Cutaneous manifestations of sarcoidosis that may suggest this disease as a cause of an associated dilated cardiomyopathy,
    • especially with heart block, intraventricular conduction delay, or ventricular
    • tachycardia
  12. high-arched palate
    is a feature of Marfan syndrome and other connective tissue disease syndromes
  13. Bifid uvula
    has been described in patients with Loeys-Dietz syndrome
  14. orange tonsils
    Tangier disease
  15. hypertelorism, low-set ears, or micrognathia
    associated with congenital heart disease
  16. Blue sclerae
    a feature of osteogenesis imperfecta
  17. A prominent venous collateral pattern
    may suggest subclavian or vena caval obstruction
  18. barrel chest deformity, especially with tachypnea, pursed-lip breathing, and use
    of accessory muscles
    suggest Obstructive lung disease
  19. Straight back syndrome
    • loss of the normal kyphosis of the thoracic spine and has been described in
    • patients with mitral valve prolapse (MVP) and its variants
  20. Systolic pulsations over the liver
    signify severe tricuspid regurgitation (TR)
  21. Ascites
    • may be present with advanced chronic right heart failure, constrictive
    • pericarditis, hepatic cirrhosis, or an intraperitonealmalignancy
  22. Clubbing
    • implies the presence of central right-to-left shunting, although it has also
    • been described in patients with endocarditis
  23. arachnodactyly or positive "wrist" (overlapping of the thumb and fifth finger around the wrist) or
    "thumb" (protrusion of the thumb beyond the ulnar aspect of the hand when the
    fingers are clenched over the thumb in a fist) sign
    Marfan syndrome
  24. Janeway lesions of endocarditis
    are nontender, slightly raised hemorrhages on the palms and soles
  25. Osler's nodes
    are tender, raised nodules on the pads of the fingers or toes
  26. Splinter hemorrhages
    • linear petechiae in the midposition of the nail bed and should be distinguished
    • from the more common traumatic petechiae, which are seen closer to the distal
    • edge
  27. Lower extremity or presacral edema in the setting of an elevated JVP
    • defines volume overload and may be a feature of chronic heart failure or
    • constrictive pericarditis
  28. Lower extremity edema in the absence of jugular venous hypertension
    • may be due to lymphatic or venous obstruction or, more commonly, to venous
    • insufficiency
  29. Muscular atrophy or the absence of hair along an extremity
    • is consistent with severe arterial insufficiency or a primary neuromuscular
    • disorder