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Auscultation of the heart requires excellent hearing and the ability to distinguish subtle differences in pitch and timing. Hearing-impaired health care practitioners can use amplified stethoscopes. High-pitched sounds are best heard with the diaphragm of the stethoscope. Low-pitched sounds are best heard with the bell. Very little pressure should be exerted when using the bell. Excessive pressure converts the underlying skin into a diaphragm and eliminates very low-pitched sounds.

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Chest pain is a very common complaint. Many patients are well aware that it is a warning of potential life-threatening disorders and seek evaluation for minimal symptoms. Other patients, including many with serious disease, minimize or ignore its warnings. Pain perception (both character and severity) varies greatly between individuals as well as between men and women. However described, chest pain should never be dismissed without an explanation of its cause. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Chest Pain are discussed.

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Chest pain is a very common complaint. Many patients are well aware that it is a warning of potential life-threatening disorders and seek evaluation for minimal symptoms. Other patients, including many with serious disease, minimize or ignore its warnings. Pain perception (both character and severity) varies greatly between individuals as well as between men and women. However described, chest pain should never be dismissed without an explanation of its cause. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Chest Pain are discussed.

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Edema is swelling of soft tissues due to increased interstitial fluid. The fluid is predominantly water, but protein and cell-rich fluid can accumulate if there is infection or lymphatic obstruction. Edema may be generalized or local (eg, limited to a single extremity or part of an extremity). It sometimes appears abruptly; patients complain that an extremity suddenly swells. More often, edema develops insidiously, beginning with weight gain, puffy eyes at awakening in the morning, and tight shoes at the end of the day. Slowly developing edema may become massive before patients seek medical care. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Edema are discussed.

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Limb pain may affect all or part of an extremity. Pain may be constant or intermittent, and unrelated to motion or precipitated by it. Accompanying symptoms and signs often suggest a source. The most common causes of pain in a limb are also readily apparent by history. Musculoskeletal injuries and overuse. This discussion covers extra-articular limb pain unrelated to injury or strain. Pain that is in only one joint or in multiple joints is discussed elsewhere. There are many causes (so called Causes of Nontraumatic Limb Pain) but the most common are the following: Deep venous thrombosis (DVT); Cellulitis. Radiculopathy; Uncommon but serious causes that require immediate diagnosis and treatment include: Acute arterial occlusion, Deep soft-tissue infection, Acute coronary ischemia (manifesting with only referred arm pain). In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Limb Pain are discussed.

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Orthostatic (postural) hypotension is an excessive fall in blood pressure (BP) when an upright position is assumed. The consensus definition is a drop of more for 20 mm Hg systolic, and 10 mm Hg diastolic, or both. Symptoms of faintness, light-headedness, dizziness, confusion, or blurred vision occur within seconds to a few minutes of standing and resolve rapidly on lying down. Some patients experience falls, syncope, or even generalized seizures. Exercise or a heavy meal may exacerbate symptoms. Most other associated symptoms and signs relate to the cause. What is Postural orthostatic tachycardia syndrome (POTS)? In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Orthostatic Hypotension are discussed.

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Palpitations are the perception of cardiac activity. They are often described as a fluttering, racing, or skipping sensation. They are common; some patients find them unpleasant and alarming. Palpitations can occur in the absence of heart disease or can result from life-threatening heart disorders. The key to diagnosis and treatment is to “capture” the rhythm on ECG and make careful observations during the palpitations. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Palpitations are discussed.

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Syncope is a sudden, brief loss of consciousness with loss of postural tone followed by spontaneous revival. The patient is motionless and limp and usually has cool extremities, a weak pulse, and shallow breathing. Sometimes brief involuntary muscle jerks occur, resembling a seizure. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Syncope are discussed.

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Dyspnea is unpleasant or uncomfortable breathing. It is experienced and described differently by patients depending on the cause. In these topic Pathophysiology, Etiology, Evaluation, Treatment, Geriatrics Essentials and Key Points of Syncope are discussed.

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