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1. General Examination in Cardiovascular System
PREPARED BY DR. RUQAYA AL-KATHIRY
HEAD OF THE MEDICAL DEPARTMENT OF UST
“Always listen
to the patient
they might be
telling you the

2. PHYSICAL EXAMINATION:
GENERAL EXAMINATION:
I-General Assessment:
The sequence & extent of examination depends on the pt's condition:
Pts. with C/P arrest requiring resuscitation: Rx 1st & examine later
Pts. requiring ER care: rapidly assess & Rx 1st, leave more detailed exam. for later
Stable pts.: examine thoroughly 1st.
Look at the pt's general appearance, noting whether he or she:
•looks unwell
•is frightened or distressed.
•Physique, form & general nourishment: BMI (??)
•obesity: C.A.D, HTN.
•thin:
•cachexic: chr. HF.
•Breathlessness at minimal exertion (dressing) or rest (semi-sitting, on 1 side).
•Vital signs
II-Hands:
1-Cyanosis: Q.DEFINE?TYPES?SITES?CAUSES?
2-Pallor: Q.DEFINE?WHAT ARE THE CARDIAC CAUSES?
3-Jaundice: Q.DEFINE?WHAT ARE THE CARDIAC CAUSES?
4-Tar Stain: Q.WHAT IS ITS SIGNIFICANCE IN THE CARDIAC DISEASES?

3. 5-Clubbing: of Fingers & Toes: Q.DEFINE?GRADES?
ASSIGNMENT:Q.WHAT ARE THE CARDIAC CAUSES OF CLUBBING?
6-Flapping Tremor (Asterixis): Q.DEFINE?TECHNIQUE?CAUSES?
III-Eyes:
IV-Neck:
1-JugularVenous Pulse (JVP):.
ASSIGNMENT: Q.WHAT ARE THE CARDIAC CAUSES OF RAISED JVP?
2-Lymph Nodes: should be examined.
V-Skin:
Erythema Nodosum=Rheumatic Fever
Rash of Systemic Lupus Erythematosus (SLE) or MS
Signs of Hyperlipidaemia:
•Corneal arcus: precipitation of cholesterol crystals=creamy yellow discoloration at the
boundary of the iris & cornea. This can occur in those >50 ys with no hyperlipidaemia.
•Xanthelasma: yellowish cholesterol plaques around the eyelids and periorbital area.
•Xanthomata: lipid deposits=yellow nodules in skin/tendons (patella/Achilles tendon).

5. Signs of Infective Endocarditis:
•Multiple capillary haemorrhages (petechiae):
In the skin, mostly on the legs & conjunctivae
caused by vasculitis.
•D/D: rash of meningococcal disease
•Roth spots:
Flame-shaped retinal haemorrhages with a
'cotton-wool' centre seen on ophthalmoscopy.
They are due to circulating immune complexes.
D/D: anaemia or leukaemia
•Splinter haemorrhages:
Multiple, linear, reddish-brown marks along
the axis of the fingernails and toenails. They are
due to circulating immune complexes.
D/D: 1-2 isolated 'splinters' are common in
healthy individuals from trauma.
•Finger clubbing:
A rare & late sign feature in chronic bacterial
endocarditis.
Microscopic haematuria.

6. •Osler’s nodes: are painful tender violaceous
raised swellings at the fingertips & toes that
are due to vasculitis; they are rare.
•Janeway lesions: are painless erythematous
flat lesions of the palms or soles.
•Mild splenomegaly or hepatosplenomegaly

7. WHAT IS THE DIAGNOSIS?

8. Q.WHAT ARE THE CAUSES OF IT UNILATERAL AND BILATERAL?

9. “Medicine is learned
at the bedside
and not in the
classroom”
Sir William Osler (1849-1919)
THANK YOU FOR YOUR ATTENDANCE