Cardiac Face Examination

Question 1

Face exam

Answer 1

• Look in the mouth for central cyanosis: a purplish blue discolouration of the lips and underside of the tongue
• Examine the eyelids for xanthelasmata: soft, yellowish plaques found periorbitally and on the medial aspect of the eyelids
• Look at the iris for corneal arcus: a creamy yellow discoloration at the boundary of the iris and cornea
• Examine the fundi (back surface of eye) for features of hypertension, diabetes or Roth’s spots (flame-shaped retinal haemorrhages with a ‘cotton-wool’ centre;

Question 2

Face- causes of examination findings

Answer 2

• Cardiac causes of central cyanosis include heart failure sufficient to cause pulmonary congestion and oedema impairing gas exchange
• or, rarely, congenital heart disease, in which case it is associated with right-to-left shunting and finger clubbing (p.326).
• Xanthelasmata and comeal arcus (see Fig. 4.6A and C) are associated with hyperlipidaemia but also occur frequently in normolipidaemic patients.
• The presence of xanthelasma is an independent risk factor for coronary heart disease and MI
• corneal arcus has no prognostic value