Cardiac Hand Examination

Question 1

Cardiac hand examination sequence

Answer 1

• Feel the temperature of the hands and measure capillary refill time.
• Examine the hands for tobacco staining, skin crease pallor (anaemia) or peripheral cyanosis.
• Look at the nails for finger clubbing and for splinter haemorrhages: linear, reddish-brown marks along the axis of the fingernails and toenails.
• Examine the extensor surface of the hands for tendon xanthomata: hard, slightly yellowish masses over the extensor tendons of the hand from lipid deposits.
• Examine the palmar aspect of the hands for:
  Janeway lesions: painless, blanching red macules on thethenar/hypothenar eminences
• Osler’s nodes: painful raised erythematous lesions, typically on the pads of the fingers

Question 2

Cardiac- hands (CRT, other indicators of disease)

Answer 2

• The hands usually feel dry and warm at ambient temperature.
• Normal capillary refill time is 2 seconds or less.
• Cool extremities and prolonged capillary refill time signify impaired peripheral perfusion, which may occur in shock
• chronic conditions associated with a low cardiac output state (as in severe aortic stenosis, mitral stenosis or pulmonary hypertension).
• One or two isolated splinter haemorrhages from trauma are common in healthy individuals, especially in manual workers.
• Splinter haemorrhages are found in infective endocarditis and some vasculitic disorders.
• A petechial rash(caused by vasculitis), most often present on the legs and conjunctivae (see Fig. 4.5E), is a transient finding in endocarditis and can be confused with the rash of meningococcal disease.
• Janeway lesions and Osler’s nodes (see Fig. 4.5A and C) are features of endocarditis but are rare
• Tendon xanthomata are a sign of familial hyper-cholesterolaemia, a genetic disorder associated with severe elevations in serum (ChE) and premature CAD