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Cardio Exam

The Palms

July 1st, 2020


During the cardiovascular examination, inspection of the palms may reveal signs suggestive of anaemia, dyslipidaemia or infective endocarditis.

Palmar Crease Pallor

Loss of colour in the palmar creases is classically a sign of anaemia, though may also occur in the context of poor peripheral perfusion.
  • Causes of Palmar Crease Pallor

  • Anaemia
  • Low cardiac output, due to cardiac disease
  • Peripheral shutdown, due to increased sympathetic activity

Osler's Nodes

Osler's nodes are a peripheral sign of infective endocarditis.
  • Look For

  • Painful nodules on the palms, soles and distal phalanges.

Janeway Lesions

Janeway lesions are a peripheral sign of infective endocarditis.
  • Look For

  • Painless flat macules on the palms, soles and distal phalanges.


Xanthomata are cholesterol-filled nodules that occur in the setting of hereditary or acquired disorders of lipid metabolism.
  • Look For

  • Red to yellow nodules, papules or plaques.
Xanthomata may overly tendons, extensor surfaces, flexor surfaces or the palms.
  • Types of Xanthomata

  • Tendinous: over tendons, ligaments, fasciaUnderlying lipid metabolism disorder
  • Planar: yellow and softHypercholesterolaemia
  • Tuberous: nodules on extensor surfaces (knees, knuckles, buttocks), palmsSystemic alteration in lipid metabolism
  • Eruptive: papules over pressure points and extensor surfacesHypertriglyceridaemia
  • Disseminatum: flexural surfaces
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