General considerations Arh
Much of the general assessment follows the pallem described for the heart and includes looking for evidence of anaemia or cyanosis, for signs of cardiac failure and for direct or indirect evidence of vascular disease (see Table 3.31). A thorough search for these signs should complement the detailed examination of the arterial pulses.
Abnormally prominent pulsation in the neck of the elderly is usually of little clinical significance being caused by arterial tortuosity rather than by a carotid aneurysm or carotid body tumour.
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TABLE 3.31 Signs suggesting vascular disease | |
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Sign |
Implication |
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Hands and arms | |
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Nicotine stains |
Smoking |
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Purple discoloration of the |
Atheroembolism from a |
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fingertips |
proximal subclavian aneurysm |
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Pits and healed scars in the |
Secondary Raynaud's syndrome |
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finger pulps | |
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Calcinosis and visible nailfold |
Scleroderma and the CREST |
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capillary loops |
syndrome |
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Wasting of the small muscles |
Thoracic outlet syndrome |
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of the hand | |
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Face and neck | |
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Corneal arcus and xanthelasma |
Hypercholesterolemia |
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Horner's syndrome |
Carotid artery dissection or aneurysm |
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Hoarseness of the voice and |
Recurrent laryngeal nerve palsy |
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'bovine cough' |
Irom a thoracic aortic aneurysm |
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Prominent veins in the neck |
Axillary/subclavian vein occlusion |
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and over shoulder and anterior | |
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chest | |
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Abdomen | |
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Epigastric/umbilical pulsation |
Aortoiliac aneurysm |
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Mottling of the abdomen |
Ruptured abdominal aortic |
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aneurysm or saddle embolism | |
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occluding aortic bifurcation | |
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Evidence of weight loss |
Visceral ischaemia |
Fig. 3.38 Examine the femoral artery, simultaneously while checking for radiofemoral delay.
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