Endocarditis: Examination

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

• General physical examination-including blood pressure, pulse, body temperature, body weight, height [weight loss]; further:
  • Inspection (viewing).
    • Skin, mucous membranes, and sclerae (white part of the eye) [petechiae (skin bleeding)].
    • Extremities [due tosymptoms:
      • Janeway lesions (pathogenesis is based on a type III hypersensitivity reaction) – small lesions (small erythematous or hemorrhagic patches or nodules) on the palms/soles of the feet; pathognomonic for infective (bacterial) endocarditis; usually the underlying bacterium is a staphylococcus
      • Osler nodules – small subcutaneous, painful, inflammatory reddened, hemorrhagic efflorescences (pathological skin changes), which are usually signs of microembolism or immune complex vasculitis in the context of infective endocarditis; especially on the hands and feet.
      • Splinter hemorrhages – bleeding under the fingernails.
      • Drumstick finger]
  • Auscultation (listening) of the heart [tachycardia (heartbeat too fast: > 100 beats per minute), arrhythmia, unspecified, heart murmur: this may change its character (decrescendoform/become quieter; crescendoform/become louder)].
  • Auscultation of the lungs [dyspnea (shortness of breath)]
  • Palpation (palpation) of the abdomen (abdomen), etc.
• ENT examination [due todifferential diagnoses:
  • Otitis media (inflammation of the middle ear).
  • Sinusitis maxillaris (maxillary sinusitis)]
• Rheumatological examination [due todifferential diagnoses:
  • Granulomatosis with polyangiitis (GPA), formerly Wegener’s granulomatosis – necrotizing (tissue dying) vasculitis (vascular inflammation) of the small to medium-sized vessels (small vessel vasculitides), which is associated with granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) as well as the lower respiratory tract (lungs).
  • Collagenoses (group of connective tissue diseases caused by autoimmune processes) – systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc) and Sharp syndrome (“mixed connective tissue disease”, MCTD).
  • Bekhterev’s disease (ankylosing spondylarthritis) – chronic inflammatory disease in which the spine and sacroiliac joints are predominantly affected.
  • Rheumatoid arthritis (synonym: chronic polyarthritis) – most common inflammatory disease of the joints]

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