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 and 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 • atherosclerosis, arteriosclerosis, hypercholesterolemia • 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 – bradyarrhythmia/bradycardia, tachyarrhythmia/tachycardia (e.g., atrial fibrillation) • coagulation disorders – hemophilia, von Willebrand disease, factor V Leiden thrombophilia, disseminated intravascular coagulopathy, pulmonary embolism, deep vein thrombosis, drug-induced coagulation disorders • edema, generalized • human immunodeficiency virus infection and AIDS • lymphatic system disorders – lymphadenopathy, lymphedema • pain, chest, ischemic and nonischemic; angina pectoris • pericardial diseases (e.g., 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
CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor
PHYSICAL EXAM FINDINGS
calf tenderness, Homans sign • cardiac auscultation, murmurs, and heart sounds • cardiac percussion and palpation (e.g., thrills, point of maximal impulse, parasternal heave) • hemodynamic assessment (e.g., blood pressure measurement, tilt test, jugular venous pressure, pulses, edema) • petechiae and purpura • vascular bruits (e.g., carotid, renal)
LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
angiography • blood types (e.g., ABO and Rh groups) • cardiac enzyme levels • CD4 count • CT scanning • D-dimer levels • ECG, 12-lead and rhythm strips • high-sensitivity troponin levels • human immunodeficiency virus testing – antibody, antigen, viral load • interpretation of complete blood count (e.g., 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 • ultrasonography
