8. Patient Presentations Related to the Circulatory and Hematologic Systems

Patient presentations span all relevant age categories, special populations, and varied clinical settings.

8.1 Cardiovascular Chest Pain
8.2 Palpitations/Rhythm Disturbances
8.3 Edema and Swelling
8.4 Masses and Lymphadenopathy
8.5 Extremity Pain and Claudication
8.6 Shortness of Breath/Dyspnea and Orthopnea
8.7 Bruising, Bleeding, and Clotting Disturbances
8.8 Circulatory Collapse and Shock
8.9 Blood Pressure Evaluation
8.10 Chest Trauma
8.11 Physical Exam Findings Related to the Circulatory and Hematologic Systems
8.12 Laboratory Test Findings and Diagnostic Imaging Related to the Circulatory and Hematologic Systems


The Guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

aortic aneurysm, thoracic – rupture, dissection • blood and blood-related diseases – anemias, leukemias, lymphomas, sickle cell disease, thrombocytopenias • blood pressure abnormalities – diastolic or systolic cardiac dysfunction, hypertension, hypertension in pregnancy, hypotension, syncope • cardiac conditions – arrest, myocardial infarction, left- or right-sided heart failure, valvular heart disease, outflow obstruction, tumors, cardiomyopathies, congenital heart diseases • cardiac rhythm disorders – bradyarrythmia/bradycardia, tachyarrythmia/tachycardia (eg, atrial fibrillation) • cardiovascular conditions – atherosclerosis, arteriosclerosis, hypercholesterolemia • coagulation disorders – hemophilia, von Willebrand disease, factor V Leiden, disseminated intravascular coagulation, pulmonary embolism, deep vein thrombosis, drug induced coagulation disorders • edema, generalized • human immunodeficiency virus and acquired immunodeficiency syndrome • lymphatic system disorders – lymphadenopathy, lymphedema • pain, chest, ischemic and nonischemic; angina pectoris • pericardial diseases (eg, pericarditis) • peripheral vascular disease/blood vessel disorders – vasculitis, venous stasis/insufficiency, arteriosclerosis, Kawasaki disease • pulse abnormalities – pulsus alternans, pulsus parvus, waterhammer pulse, delayed/unequal pulses • shock – septic, anaphylactic

fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

calf tenderness and Homans sign • cardiac auscultation, murmurs, and heart sounds • cardiac percussion and palpation (eg, thrills, point of maximal impulse, parasternal heave) • hemodynamic assessment (eg, blood pressure measurement, tilt test, jugular venous pressure, pulses, edema) • petechiae and purpura • vascular bruits (eg, carotid, renal)

angiography • blood types (eg, ABO and Rh groups) • cardiac enzymes • CD4 • computed tomography imaging • D-dimer • electrocardiogram, 12-lead and rhythm strips • high-sensitivity troponin • human immunodeficiency • testing, antibody, antigen, viral load • interpretation of complete blood count (eg, anemia, thrombocytopenia, neutropenia, neutrophilia, polycythemia) • iron studies • magnetic resonance imaging • nuclear medicine imaging • peripheral blood smear • prothrombin time, international normalized ratio, partial thromboplastin time, hemoglobin electrophoresis • radiography • reticulocyte count • serum protein electrophoresis • sonography