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Heart Disease and not have the findings
From head to toe, a few things come to mind. Now keep in mind that these observations are neither sensitive nor specific. You can have heart disease and not have the findings, or you can have the findings and not have heart disease. It’s also a matter of severity. A person can have heart disease, that has developed so slowly over time, they barely notice it themselves. On the other hand, if structural or mechanical failure is sudden or acute, they will complain.
Now note also that if what you’re saying is I happened to look in that direction and this is what I noticed, that’s one thing, but a doctor visit should start out with what the patient has to say and then guiding the patient through a series of related questions. One of the things I’ve told my students and my children for decades is I will help you learn what questions to ask and how to ask them. It’s a matter of detective work.
The patient can look fatigued
The patient can look fatigued overall patient can seem to have a hard time breathing and even weakness and fatigue. Color can be poor sometimes even gray, and if the heart disease is related to anemia, they may be pale. Sometimes the lips are blue, this is known as cyanosis. Sometimes the cheeks are flushed and valvular disease and the facial structure can seem pinched if it’s been present since early childhood or congenital. That’s not seen too often anymore.
Sometimes the eyes will seem widened that could be because the patient recognizes their distress. The patient may look as if they feel an impending sense of doom. Sometimes you can see jugular venous distention, which is a column of blood expanding the jugular veins above the level of the clavicles. That indicates elevated central venous pressure, which generally indicates right-sided cardiac failure. A very subtle observation might be what is called Cheyne-Stokes ventilation,
where there is a cycle that can last anywhere from a portion of a minute to several minutes of deeper and deeper and faster and faster ventilation, which then starts to slow down and become very shallow. It’s characteristic of heart failure due to the delayed circulation time.
Granted that this is touching
Granted that this is touching not just looking, but the liver can be dilated with its edge well below the right rib margin. If it’s palpable, and one press on it, it is likely that the jugular veins will distend further. That’s called a paddle jugular reflux and is the result of the pressure on the liver causing an increase in the splanchnic venous return into the central circulation.
Most importantly and most famously although it’s not always present is pedal or ankle edema. The right side of the heart supposed to take blood from the circulation and bring it back into the central circulation but if it is unable to do so, in a manner of speaking the veins back up and result in fluid being retained in the lowermost portions of the body. It is a hydraulic phenomenon. The very abnormal fingernails (and occasionally rarely toenails) are due to hypertrophic osteodystrophy, A very chronic and very gradual swelling of the structures underneath the nails and the periostin around the bone. It probably has more to do with chronic hypoxia, that is low oxygen, then it has to do directly with heart disease
. On occasion, it may be possible to see the heartbeat “banging” against the chest wall at the point of maximum impulse. It is also possible to see what is called titubation that is a pendulum-like the vertical action of the head, neck, or even in severe cases of the upper chest or entire body. I’ve seen that personally, in fact, I experienced it personally. On occasion, you can literally hear a hooting or whistle from an abnormal heart valve. Even without a stethoscope.
Now the very articulate doctor from Hong Kong down below is describing mostly findings that are suggestive of related phenomena, for instance, bruising may, in fact, be due to taking an anticoagulant. Xanthelasma does not indicate heart disease but rather hyperlipidemia. Arcus and Ellis is a white ring around the iris that also indicates hyperlipidemia I thought. I thought that Frank’s sign of the earlobe crease was disproved long ago.
The rest of his synopsis is superb.
Even I viewed it as a refresher. In addition to these straightforward visual observations, there are dozens and dozens of signs (objective findings) based on contact auscultation palpation, etc. during a physical examination. Don’t forget, by tradition and common sense, the physical examination comes after history. The patient gives a complaint, guided questions are asked answered and elaborated upon, and it is important to assess onset predisposition, provocation persistence severity, and timing, Among other things. Plus it’s best to know what other medical conditions the patient may have because certain diseases and disorders of the internal organs may make important considerations for what treatments will be given.
Clinical cardiology is one of the oldest and most developed of the clinical forms of physical examination, but for better or for worse, much of the physical examination has been replaced by technology, specifically echocardiograms nuclear scans, and electrocardiograms, and many more.