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)