“CVS Examination & Physiological Changes in CVS System During PREGNANCY"

General Examination

FACIES

• Apprehensive facies produced by pain, anxiety and respiratory distress (MI, angina, PE, arrhythmias as VT, fast AF)

A ) Skin Color and Texture

• Malar flush: long-standing MS,

• Brick red color of polycethemia (may cause HTN, thrombosis, MI)

• Central cyanosis (right to left intracardiac shunt or lung disease.

B) Eyes and Lids

• Xanthelasma (hypercholesterolemia, DM)

• Lid edema (myxedema, nephrotic syndrome, SVC syndrome…)

• Exophthalmos, lid retraction in thyrotoxicosis (A.F, high output failure)

• Corneal arcus in young people indicates severe hypercholesterolemia

C) Bony Developmental Abnormality

• Marfan syndrome (with long narrow face, lens sublaxation, long arm, arachnodactyly) (AR,aortic dissection, MVP)

• Williams syndrome (small elf-like forehead, turned up nose, egg shaped teeth, low set ears)

• Noonan’s sydrome (widely set eyes, web neck) associated with PS

D) Hands

• Tremor may indicate thyrotoxicosis (AF, CHF)

• Clubbing of the fingers (cardiac cause: CHD, IE)

• Capillary pulsation (AR, thyrotoxicosis, pregnancy)

• Splinter hemorrhage (IE , acute GN)

• Osler’s nodes (0.5-1 cm painful reddish- brown subcutaneous papules occur on the tip of the fingers or toes, palm of the hand, planter aspect of the feet (IE)