Angina Pectoris: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin and mucous membranes [in left heart failure (left ventricular failure):
      • Neck vein congestion? [Caveat (Warning): May be absent in acute heart failure.]
      • Cyanosis? (purplish-bluish discoloration of oral mucosa, tongue, lips and conjunctiva due to decreased oxygen saturation of the blood).
      • Leg edema? (fluid accumulation in the legs) in heart failure / cardiac insufficiency.
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture?
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels?
      • Scars? Hernias (fractures)?
  • Auscultation (listening) of the heart (aortic valve stenosis? spindle-shaped rough systolic p.m. 2nd ICR (intercostal space) right parasternal, continued into the carotids), carotid artery and peripheral arterial vessels (complete vascular status).
  • Auscultation of the lungs [in left heart failure:
    • Congestive bronchitis with irritable cough.
    • Possibly rusty brown sputum
    • Pulmonary edema (fluid in the lungs): tachypnea (> 20 breaths/min); exacerbated breath sounds; inspiratory: bds. moist rales (RGs)/coarse bubbles rales; in severe cases already audible without stethoscope (“bubbling of the lungs”); the breath sound is attenuated]
  • Examination of the abdomen (abdomen)
    • Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
    • Percussion (tapping) of the abdomen [in heart failure (cardiac insufficiency): hepatomegaly (liver enlargement)? (congested liver)]
      • Attenuation of palpitation due to enlarged liver or spleen, tumor, urinary retention?
      • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?).
• Health check; furthermore, the likelihood of a depressive disorder should be assessed using screening questions in the medical history interview or standardized questionnaires [S3 guideline].

Square brackets [ ] indicate possible pathological (pathological) physical findings.