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, mucous membranes and sclerae (white part of the eye).
- Inspection of the entire body with special attention to central and peripheral signs of congestion.
- Neck vein congestion?
- Edema (praetibial edema?/water retention in front of the tibia; in supine patients: presacral).
- Generalized peripheral cyanosis (blue coloration of skin and mucous membranes)?
- Auscultation (listening) of the heart; in heart failure (cardiac insufficiency):
- Displaced (and widened) cardiac apex (placing the palm of the hand on the left parasternal facilitates finding the cardiac apex; this is assessed with two fingers: Location, extension, and strength)?
- Auscultation findings: present 3rd heart sound (time: early diastole (relaxation and filling phase of the heart); approx. 0.15 sec. after the 2nd heart sound; due to the impingement of the blood jet on the stiff wall of the (insufficient) ventricle/heart chamber)?
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- Auscultation (listening) of the lungs.
- Palpation (palpation) of the abdomen (abdomen), etc.
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of the prostate in size, shape and consistency, if necessary, detection of indurations / hardening of tissue).
- Inspection (viewing).
- If necessary, gynecological / urological examination.
- If necessary cancer screening
