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) due topossible:
- Neck vein congestion?
- Signs of increased right ventricular filling pressure include jugular venous congestion (JVD) or increased jugular venous pressure (JVP).
- Elevated JVD is commonly seen in patients with decompensated heart failure.
- Hepatojugular reflux (HJR): reliably indicates increased pulmonary capillary wedge pressure (PCWP)Positive HJR: when the jugular vein remains congested (JVP 3 cm) for the entire time during a 10-second abdominal squeeze, and JVP abruptly decreases thereafter [Positive HJR is associated with a worse prognosis].
- 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]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Neck vein congestion?
- Auscultation (listening) of the heart.
- Auscultation of the lungs [rales (RGs)?
- Abdominal examination [hepatomegaly (liver enlargement)? (congested liver); splenomegaly (splenomegaly)? (secondary to portal hypertension/pulmonary hypertension)]
- Auscultation (listening) of abdomen [vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly and/or splenomegaly: estimate liver and spleen size.
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
- Inspection (viewing) due topossible:
- 6-Minute Walk Test – standardized procedure for objective assessment, determination of severity, and progression of exercise limitation attributable to cardiopulmonary causes (at baseline and during the course of the disease).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.