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
- Auscultation (listening) of the heart [due todifferential diagnoses:
- Angina pectoris (“chest tightness”; sudden onset of pain in the region of the heart).
- Aortic aneurysm – circumscribed main artery dilation due to congenital or acquired weakening of the arterial wall.
- Aortic dissection (synonym: aneurysm dissecans aortae) – acute splitting (dissection) of the wall layers of the aorta (main artery), with a tear of the inner layer of the vessel wall (intima) and hemorrhage between the intima and the muscle layer of the vessel wall (outer media), in the sense of an aneurysm dissecans (pathological expansion of the artery).
- Aortic stenosis – obstruction (narrowing) of the outflow tract of the left ventricle.
- Pericardial tamponade – constriction of the heart by the pericardium.
- Hypertrophic cardiomyopathy – weakness of the heart muscle with enlargement of the heart and a tendency to severe arrhythmias, especially under stress.
- Unstable angina pectoris (UA; English unstable angina) – one speaks of an unstable angina pectoris, if the complaints have increased in intensity or duration compared to the previous angina pectoris attacks.
- Kawasaki syndrome – acute, febrile, systemic disease characterized by necrotizing vasculitis (vascular inflammation) of the small and medium-sized arteries
- Myocardial infarction (heart attack).
- Pericardial effusion – fluid accumulation in the pericardium pericarditis (pericarditis).
- Prinzmetal angina – special form of angina pectoris (chest tightness, heart pain) with transient ischemia (circulatory disorder) of the myocardium (heart muscle) triggered by a spasm (spasm) of one or more coronaries (coronary arteries) (symptoms: pain duration: seconds to minutes; load-independent, especially in the early morning hours). As the worst consequence of ischemia, a myocardial infarction (heart attack) can be triggered.
- X syndrome – simultaneous presence of exercise-induced angina, a normal exercise ECG, and angiographically normal coronary arteries (small vessel disease)]
- Auscultation of the lungs [due todifferential diagnoses:
- Bronchial asthma
- Bronchitis – inflammation of the bronchi.
- Foreign body aspiration – inhalation of foreign bodies.
- Pulmonary embolism – occlusion of one or more pulmonary vessels by a thrombus (blood clot).
- Mediastinitis – inflammation in the mediastinum (space in the chest located between the lungs).
- Pleurisy (sicca) (pleurisy).
- Pneumonia (pneumonia)
- Pneumothorax – lung collapse, which is further complicated by a valve mechanism.
- Pulmonary hypertension (pulmonary hypertension)]
- Inspection (viewing).
- Orthopedic examination [due todifferential diagnoses:
- Rib fracture (rib fracture) – symptoms: bruise marks, hematomas, pain related to breathing and movement.
- Rib contusion – symptoms: possible bruise marks, hematomas, respiratory and movement-dependent pain]
- Psychiatric examination [due todifferential diagnoses:
- Anxiety disorders
- Depression
- Mental illnesses such as anxiety disorders with panic attacks]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
