The Physical Examination in Cardiovascular Disease: The Extremities

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: arterial murmur

Arterial bruits is the term for the unusual swishing sound that blood makes when it rushes past an obstruction (called turbulent flow) in an artery when the sound is auscultated with the bell portion of a stethoscope.

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

There are no known life threatening causes of arterial bruit that would result in death or permanent disability if not treated within 24 hours.

• Aortic coarctation
• Arterial aneurysm
• Arteriosclerosis
• Arteriosclerotic plaque
• Arteriovenous fistula
• Carotid artery stenosis
• Carotid atherosclerosis
• Carotid-cavernous fistula
• Peripheral vascular disease

Template:WH Template:WS CME Category::Cardiology

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Amandeep Singh M.D.[3], Chandrakala Yannam, MD [4]

Diagnostic Study of Chocie | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | Echocardiography or Ultrasound | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Martin Nino, M.D. [2]

Synonyms and keywords: oedema or œdema

Edema (American English), formerly known as dropsy or hydropsy, is the increase of interstitial fluid in any organ — swelling. Generally, the amount of interstitial fluid is in the balance of homeostasis. Increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema. Cutaneous edema is referred to as “pitting” when, after pressure is applied to a small area, the indentation persists after the release of the pressure.

Edema can be classified into pitting edema and non piting edema. Peripheral pitting edema is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis. Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipedema, and myxedema.

Generation of interstitial fluid is regulated by the Starling equation of tissue fluid which states that it depends on the balance of osmotic pressure and of hydrostatic pressure which act in opposite directions across the semipermeable capillary walls. Consequently, anything that increases oncotic pressure outside blood vessels (for example inflammation), or reduces oncotic pressure in the blood (states of low plasma osmolality, for example cirrhosis) will cause edema. Increased hydrostatic pressure inside the blood vessel (for example in heart failure) will have the same effect. If the permeability of the capillary walls increases, more fluid will tend to escape out of the capillary, as can happen when there is inflammation.

Causes of edema can be grouped by its extension as generalized and localized edema. Other way to classify it is by its primary mechanism: Increased capillary hydraulic pressure, hypoalbuminemia, increased capillary permeability, lymphatic obstruction or increased interstitial oncotic pressure.

Life threatening causes of edema are:^[1][2][3]

• Acute kidney failure
• Acute pulmonary edema
• Adult respiratory distress syndrome
• Anaphylaxis
• Anthrax
• Burns
• Eclampsia
• Ischemic heart disease
• Sepsis

• Cirrhosis
• Drugs
• Heart failure
• Nephrotic syndrome and other forms of renal disease
• Pregnancy
• Premenstrual edema
• Venous insufficiency

Edema of specific organs (cerebral edema, pulmonary edema, macular edema, pedal edema) may also occur, each with different specific causes to peripheral edema, but all based on the same principles. Ascites is effectively edema within the peritoneal cavity, as pleural effusions are effectively edema in the pleural cavity. Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause peripheral edema, pulmonary edema, pleural effusions and ascites.

Common and usually harmless appearances of cutaneous edema are observed with mosquito bites and skin contact with certain plants (urticaria).

Edema may be found in the eyes after corrective surgery or procedures of that nature.

• Medline Encyclopedia – Swelling

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources