-
Central cyanosis
significant right-to-left shunting at the level of the heart or lungs
-
Peripheral cyanosis or acrocyanosis
- reduced extremity blood flow due to small vessel constriction, as seen in
- patients with severe heart failure, shock, or peripheral vascular disease
-
Differential cyanosis
- isolated cyanosis affecting the lower but not the upper extremities in a patient
- with a large patent ductus arteriosus (PDA) and secondary pulmonary hypertension
- with right-to-left to shunting at the great vessel level
-
Malar telangiectasia
are seen in patients with advanced mitral stenosis and scleroderma
-
Hereditary telangiectasias on the lips, tongue, and mucous membranes
- as part of the Osler-Weber-Rendu syndrome (hereditary hemorrhagic
- telangiectasia), resemble spider nevi and can be a source of right-to-left
- shunting when also present in the lung
-
tan or bronze discoloration of the skin
- may suggest hemochromatosis as the cause of the associated systolic heart
- failure
-
eruptive xanthomatosis and lipemia retinalis
Severe hypertriglyceridemia
-
Palmar crease xanthomas
are specific for type III hyperlipoproteinemia
-
Pseudoxanthoma elasticum
- a disease associated with premature atherosclerosis, is manifested by a
- leathery, cobblestoned appearance of the skin in the axilla and neck creases and
- by angioid streaks on funduscopic examination
-
Extensive lentiginoses
- have been described in a variety of development delay–cardiovascular syndromes,
- including Carney syndrome, which includes multiple atrial myxomas
-
lupus pernio and erythema nodosum
- Cutaneous manifestations of sarcoidosis that may suggest this disease as a cause of an associated dilated cardiomyopathy,
- especially with heart block, intraventricular conduction delay, or ventricular
- tachycardia
-
high-arched palate
is a feature of Marfan syndrome and other connective tissue disease syndromes
-
Bifid uvula
has been described in patients with Loeys-Dietz syndrome
-
orange tonsils
Tangier disease
-
hypertelorism, low-set ears, or micrognathia
associated with congenital heart disease
-
Blue sclerae
a feature of osteogenesis imperfecta
-
A prominent venous collateral pattern
may suggest subclavian or vena caval obstruction
-
barrel chest deformity, especially with tachypnea, pursed-lip breathing, and use
of accessory muscles
suggest Obstructive lung disease
-
Straight back syndrome
- loss of the normal kyphosis of the thoracic spine and has been described in
- patients with mitral valve prolapse (MVP) and its variants
-
Systolic pulsations over the liver
signify severe tricuspid regurgitation (TR)
-
Ascites
- may be present with advanced chronic right heart failure, constrictive
- pericarditis, hepatic cirrhosis, or an intraperitonealmalignancy
-
Clubbing
- implies the presence of central right-to-left shunting, although it has also
- been described in patients with endocarditis
-
arachnodactyly or positive "wrist" (overlapping of the thumb and fifth finger around the wrist) or
"thumb" (protrusion of the thumb beyond the ulnar aspect of the hand when the
fingers are clenched over the thumb in a fist) sign
Marfan syndrome
-
Janeway lesions of endocarditis
are nontender, slightly raised hemorrhages on the palms and soles
-
Osler's nodes
are tender, raised nodules on the pads of the fingers or toes
-
Splinter hemorrhages
- linear petechiae in the midposition of the nail bed and should be distinguished
- from the more common traumatic petechiae, which are seen closer to the distal
- edge
-
Lower extremity or presacral edema in the setting of an elevated JVP
- defines volume overload and may be a feature of chronic heart failure or
- constrictive pericarditis
-
Lower extremity edema in the absence of jugular venous hypertension
- may be due to lymphatic or venous obstruction or, more commonly, to venous
- insufficiency
-
Muscular atrophy or the absence of hair along an extremity
- is consistent with severe arterial insufficiency or a primary neuromuscular
- disorder
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