Clinics in chest medicine
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The physical examination, that is, inspection, palpation, and auscultation, is as valuable today as it ever was, even for structures as inaccessible as the heart and pulmonary circulation. Examination of the heart in patients with lung disease aims to detect changes in the structures or function of the right heart that are secondary to the pulmonary process and to detect the circulatory status of the patient. The most important cause of changes in the right ventricle in patients with lung disease is increased afterload caused by pulmonary hypertension. Auscultation remains one of the most sensitive means of detecting pulmonary hypertension, and the physical signs allow assessment of right ventricular function as well as response to therapy.
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Multiple physiologic and psychologic factors contribute to the sensation of acute as well as chronic dyspnea. The causes of acute dyspnea frequently can be established by a brief history, physical examination, and chest radiograph. Appropriate therapy should be directed to reversing the specific etiology leading to the acute onset of breathlessness. ⋯ This baseline assessment provides objective information for evaluating response to treatment. Initial therapy for improving chronic breathlessness should be directed at the specific cause of the problem. Additional strategies for reducing dyspnea include breathing techniques, exercise training, nutritional manipulations, psychologic interventions, respiratory muscle training, respiratory muscle rest, and sedative/hypnotic medications.
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Accurate diagnosis is essential for effective treatment. After history-taking, the physical examination is second in importance in assessing a pulmonary patient. The time-honored sequence of inspection, palpation, percussion, and auscultation is appropriate. ⋯ Its appropriate use improves medical practice and reduces costs. Improvements in sound recording and analysis techniques have spurred a renewed interest in lung sounds and their meaning. This is likely to lead to better understanding of what we hear, and perhaps to the development of new noninvasive diagnostic and monitoring techniques.