Pericarditis: Examination

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 [edema (water retention) to anasarca (accumulation of edema/tissue fluid in the connective tissue of the subcutis), thus generalized edema/water retention (i.e., on the complete body)]
      • Neck vein congestion? [Pericarditis constrictiva: paradoxical increase in jugular venous congestion during inspiration (inhalation) = Kussmaul sign]
      • Central cyanosis? [bluish discoloration of skin and central mucous membranes, e.g., tongue]
    • Pulse palpation [pulsus paradox: drop in systolic blood pressure > 10 mmHg during inspiration (inspiration), with the consequence that the pulse is markedly attenuated during inspiration (due toconstriction of the pericardium): constrictive pericarditis]
    • Auscultation (listening) of the heart [dry pericarditis: near-ear, systolic-diastolic rough rubbing sound; wet pericarditis: heart sounds become quieter]
    • Examination of the lungs (due topossible sequelae).
      • Auscultation (listening) of the lungs [due toright heart failure (right heart weakness): plueraerguss].
      • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (eg. e.g. in pneumonia/pulmonary inflammation) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent: e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
      • Percussion (tapping) of the lungs [e.g., in emphysema; box tone in pneumothorax]
      • Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e. e.g., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with pleural effusion, pneumothorax, emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
    • Examination of the abdomen (abdomen) [due to right heart failure: hepatomegaly, splenomegaly, ascites].
      • Percussion (palpation) of the abdomen.
        • Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (undulation phenomenon); flank attenuation.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
      • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?).

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