Table 2: Focused inspection

Physical Finding Associated cardiac condition(s)
Head & Neck
De Musset sign (head bobbing) Aortic regurgitation
Hoarseness Pericardial effusion, thoracic aneurysm
Hiccups Pericardial effusion (phrenic nerve stimulation)
Dislocated lens / ectopialentis (Marfanís syndrome) Aortic regurgitation, mitral valve prolapse
Blue Sclera, brittle bones (Osteogenesisimperfecta) Mitral valve prolapse, aortic dilation/regurgitation and dissection
Bilateral forward displacement of eyeballs (Graves' ophthalmopathy) Tachycardia, atrial fibrillation, high output heart failure
Systolic pulsation Severe tricuspid regurgitation
Pectusexcavatum, straight/ flat thoracic spine (Straight-back syndrome, ankylosing spondylitis) Mitral valve prolapse syndrome, aortic regurgitation
Hands & Legs
Unilateral digital clubbing Aortic aneurysm (interferes with blood supply to one arm), brachial arteriovenous fistula, arterial graft sepsis, & hemiplegic stroke
Bilateral digital clubbing Cyanotic congenital heart disease, neoplastic & suppurative intrathoracic disease, diffuse pulmonary disease, infective endocarditis, inflammatory bowel disease, celiac disease, cirrhosis, thyroid acropachy (extreme autoimmune thyroid disease)
Ulnar deviation, "swan neck" (rheumatoid arthritis) Aortic regurgitation, mitral regurgitation, pericarditis, cardiomyopathy
Arachnodactyly "spider fingers" long and slender digits (Marfanís syndrome) Aortic regurgitation, mitral valve prolapse
Xanthoma Hypercholesterolemia
Systolic blush & diastolic blanch when upward traction on the fingernail (Quincke's pulse) Aortic regurgitation
Thumb with extra phalanx (Holt-Oram syndrome) Atrial septal defect
Petechiae Infective endocarditis, trauma
Painless hemorrhagic lesions on palms or soles (Janeway lesions) Infective endocarditis
Small tender erythematous skin lesions on pads of the fingers, toes, palms or soles (Osler nodes) Infective endocarditis
Triphasic (white, blue, red) change of finger color in cool temperatures or emotional stress Raynaudís phenomenon
Bilateral peripheral edema Excess extracellular fluid (5 liters or more): heart failure, constrictive pericarditis
Unilateral peripheral edema Venous obstruction/damage/removal, hemiplegia (on paralyzed side)