The Cardiac Exam: Inspection
Introduction
Like any part of the physical exam a thorough cardiac exam should begin with inspection. For the cardiac exam the patient should be supine at 30 degrees, ideally without any clothes on their chest or just a bra, or at the most a hospital gown. A thorough inspection for the cardiac exam involves not only looking at the area of the body in close proximity to the heart (chest), but also other areas of the body (eyes, mouth, skin), which although anatomically remote to the heart, give us a window into the cardiovascular system.
Signs
Chest
Observe the chest for overall torso contour.
- Do you see pectus excavatum (caved-in chest)?
- Do you see pectus carinatum (pigeon chest)?
- Can you see any cardiac motion?
Pectus Exacavatum Pectus Carinatum
Eyes
The presence of yellowish plaques
on the eyelids (xanthelasma) could indicate hyperlipoproteinemia, a risk factor for hypertension as
well as arteriolosclerosis.
Xanthelsma
Mouth
The presence of petechiae (small red or purple spots containing blood that appears in skin or mucous membrane), shown here on the skin, but which can also appear on mucous membranes, especially on the palate, can be a sign of subacute endocarditis.
Skin
Clubbing
The presence of clubbing (broadening of the extremities of the
digits, accompanied by nails which are abnormally curved and shiny) indicates
chronic poor oxygen perfusion to the distal tissues of the hand and feet.
Clubbing
Cyanosis
The presence of cyanosis (bluish color) also denotes
chronic poor oxygen delivery to the peripheral tissues of the hands and feet.
Cyanosis can be found in patients with many different cardiac and
pulmonary conditions.
Cyanosis
Edema
The presence of edema (tissue swelling) can be caused
by several factors, although most commonly is associated with decreased cardiac
function leading to decreased capillary flow. This decreased flow in
turns leads to increased fluid perfusion, especially in the gravity dependent
areas of the body (e.g. arms and legs) which causes the swelling.
Xanthomas
The presence of yellowish plaques under the skin
(non-eruptive) excoriated through the skin (eruptive) could indicate hyperlipoproteinemia, a risk factor for hypertension as
well as arteriolosclerosis.
Close-up on skin
On joints
Over tendons
Xanthomas (non-erruptive)
Xanthomas (erruptive)
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(19 December 2008)
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