From the Guidelines
A cardiovascular physical exam examining with your eyes includes visual observations of skin color and appearance, jugular venous distention, abnormal chest wall movements, edema in the extremities, and other signs of cardiovascular dysfunction. These visual findings can provide important diagnostic information and signal potential cardiovascular issues that warrant further investigation. According to the 2009 ACCF/AHA focused update on perioperative beta blockade 1, the general appearance of the patient provides invaluable evidence regarding their overall status, including clues such as cyanosis, pallor, dyspnea, Cheyne-Stokes respiration, poor nutritional status, obesity, skeletal deformities, tremor, and anxiety.
Some key visual observations to look out for include:
- Skin color and appearance, such as cyanosis, pallor, or jaundice
- Visible pulsations in the neck, indicating jugular venous distention
- Abnormal chest wall movements or visible cardiac impulses
- Edema in the extremities
- Clubbing of fingers
- Changes in nail beds
- Signs of poor perfusion, such as delayed capillary refill
- Surgical scars indicating previous cardiac procedures
- Visible varicose veins suggesting venous insufficiency
- Xanthomas (fatty deposits) that might indicate lipid disorders
These visual components of the exam are valuable because they can immediately signal cardiovascular dysfunction without requiring specialized equipment, as noted in the 2009 ACCF/AHA guidelines 1. They represent the initial step in cardiac assessment before proceeding to palpation, percussion, and auscultation, allowing clinicians to quickly identify potential cardiovascular issues that warrant further investigation.
From the Research
Visible Signs of Cardiovascular Issues
During a cardiovascular physical exam, several signs can be visible to the eye, indicating potential issues. These include:
- Cyanosis, a bluish discoloration of the skin and mucous membranes, which can be a sign of hypoxemia 2, 3
- Clubbing of the fingers, which can be a sign of chronic hypoxemia 3
- Peripheral edema, or swelling in the legs and feet, which can be a sign of heart failure
- Jugular venous distension, or swelling of the jugular vein, which can be a sign of heart failure
- Spider nevi, or small, dilated blood vessels near the surface of the skin, which can be a sign of liver disease or heart failure
Skin and Mucous Membrane Changes
Changes in the skin and mucous membranes can also be visible signs of cardiovascular issues. These include:
- Pallor, or pale skin, which can be a sign of anemia or poor circulation
- Cool or cold skin, which can be a sign of poor circulation
- Diaphoresis, or excessive sweating, which can be a sign of heart failure or other cardiovascular conditions
Other Visible Signs
Other visible signs of cardiovascular issues can include:
- Enlargement of the liver or spleen, which can be a sign of heart failure or other cardiovascular conditions
- Ascites, or fluid accumulation in the abdomen, which can be a sign of heart failure or liver disease