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) [especially due topossible sequelae: heart failure (cardiac insufficiency)].
- Skin and mucous membranes
- Neck vein congestion?
- Edema (praetibial edema?/water retention in the area of the lower leg/before the tibia, ankle; in supine patients: presacral/before the sacrum).
- Central cyanosis (bluish discoloration of skin and central mucous membranes, e.g. tongue)? etc.
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation (listening)
- Heart (auscultation findings: possible flow murmur over left ventricle/left ventricle outflow tract; third heart sound/if present: Indication of heart failure/heart failure; arrhythmia? ; in advanced hypertensive heart disease due to chronic pressure load and transition to eccentric hypertrophy (cardiac enlargements) → insufficiency vitiation, e.g., of the mitral valve); cardiac or thoracic murmurs? (Aortic isthmus stenosis, aortic diseases).
- Carotid artery bds.
- Abdomen (abdomen) (auscultation of central arteries with attention to flow sounds).
- Leg arteries
- Auscultation of the lungs [due topossible sequelae: heart failure (cardiac insufficiency)] [rales (RGs)?]
- Examination of the abdomen (abdomen)
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?]
- Percussion (tapping) of the abdomen [hepatomegaly?/stasis liver; splenomegaly?/secondary to portal hypertension]
- Palpation (palpation) of the abdomen (abdominal) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?
- Palpation of the pulses [due topossible secondary disease: Peripheral arterial occlusive disease (pAVK)]
- Inspection (viewing) [especially due topossible sequelae: heart failure (cardiac insufficiency)].
- Ophthalmological examination – detection of disturbances in vision due to fundus changes [due topossible sequelae:
- Amaurosis (blindness)
- Retinopathy (changes in the retina leading to visual disturbances)]
- Nephrological examination [due topossible secondary diseases:
- Nephropathy (kidney disease) with albuminuria/proteinuria (increased excretion of protein in urine).
- Renal insufficiency (kidney weakness)
- Renal failure]
- Neurological examination – including pupillary response, testing of sensitivity and motor function, checking reflexes [due topossible sequelae:
- Hypertensive encephalopathy – hypertensive emergency characterized by an increase in intracranial (within the skull) pressure with consequent intracranial pressure signs.
- Intracerebral hemorrhage (ICB; cerebral hemorrhage).
- Cerebral circulatory disorders – circulatory disorders of the brain]
- Health Check
Square brackets [ ] indicate possible pathological (pathological) physical findings. * The arterial blood pressure is characterized by a wide range of fluctuation. This is true for fluctuations within one day as well as in comparison of several days. Therefore, in order to make the diagnosis of hypertension, blood pressure must be elevated in at least three measurements. The measurements must take place at at least two different times and should be performed on both arms. Note: Blood pressure difference between right and left arm (aortic isthmus stenosis, stenoses of the subclavian artery). It makes sense to use a long-term blood pressure monitor to perform a 24-hour blood pressure measurement. In this case, the device automatically measures the current blood pressure at set intervals and stores these values so that they can be evaluated later.