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 the mucous membranes
- Because of possible concomitant heart failure (cardiac insufficiency) as a complication:
- Neck vein congestion? [Caveat (Warning)! May be absent in acute heart failure.]
- Edema (praetibial edema?/water retention in the area of the lower leg/pretibial (in front of the tibia), ankle; in supine patients: presacral/in front of the sacrum).
- Generalized peripheral cyanosis [blue coloration of lips and acras (finger/toe extremities, nose, ears]
- Central cyanosis [bluish discoloration of skin and central mucous membranes, e.g., tongue]
- Because of possible concomitant heart failure (cardiac insufficiency) as a complication:
- Skin and the mucous membranes
- Auscultation (listening) of the heart [due todifferential diagnoses:
- Extrasystoles (cardiac stumbles; heartbeat that occurred outside the normal heart rhythm), both ventricular (originating in the ventricles) and supraventricular (originating in the atrium).
- Valvular defects, unspecified Cardiac arrhythmias of all types.
- Cardiomyopathy – structural heart disease leading to limitations in performance.
- Pacemaker tachycardia – pacemaker-induced pulse rate > 100 beats/min.
- Shunt vitia – congenital heart defects in which there is a circulatory short circuit]
- Inspection (viewing).
- If necessary, psychiatric examination [due todifferential diagnoses:
- Anxiety disorders
- Depression
- Panic disorder
- Stress and stressful situations]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
