By Jules Constant;
Vital for everybody who's drawn to the additional little bit of wisdom approximately cardiac actual examination, old style!
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Extra resources for Essentials of Bedside Cardiology (Contemporary Cardiology) by Jules Constant (2002-11-19)
They also have pericardial effusions. 5. What is meant by an earlobe crease, and what is its significance? ANS: This is an oblique crease in the earlobe. Ninety percent of patients over age 50 with significant triple vessel coronary disease have a deep earlobe crease. A unilateral ear crease was found in one study to be associated with an intermediate degree of coronary obstruction . (See p. ) 22 Essentials of Bedside Cardiology This 47-year-old man had this deep ear crease bilaterally. Although he had no significant coronary disease, his cholesterol-to-HDL ratio was 8 to 1, and he had sinus node dysfunction.
The earliest sign of clubbing is probably the reduction or absence of the groove where the root of the nail slips under the skin. Moist, warm fingertips are often associated signs. 3. How should you test for mild clubbing? ANS: a. Look for obliteration of the normal angle between the base of the nail and the proximal skin. Boldface type indicates that the term is explained in the glossary. 17 18 Essentials of Bedside Cardiology The feet of this 23-year-old man with a reversed shunt through a persistent ductus were cyanotic and clubbed, while his hands were normal.
The normal patient at left cannot overlap his thumb and little finger around his wrist because, unlike the patient with the Marfan syndrome at right, his fingers are not long relative to his wrist. EXTREMITIES 1. What hand, wrist, and extremity findings suggest the Marfan syndrome, with its possible cardiac abnormalities of aortic regurgitation and prolapsed mitral valve? ANS: a. Fingers: slender and long (“spider” fingers, or arachnodactyly). b. Thumb sign: when a fist is made over a clenched thumb, the thumb should not extend beyond the ulnar side of the hand.