Patient Presentations 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