Page 30 - Clinical Pearls in Cardiology

18 Clinical Pearls in Cardiology

Deeper cyanosis of the upper part of the body than the
lower part of the body, or reversed differential cyanosis,
is a rare but important physical sign. In this condition,
the toes are pink and the hands are blue. It is seen in
complete transposition of great arteries associated with
pulmonary hypertension and PDA.
28. What are the cardiac causes for clubbing of fingers?
The commonest cardiac causes for clubbing of fingers
are: (1) Cyanotic congenital heart diseases; (2) Infective
endocarditis; (3) Atrial myxoma. Differential clubbing
and differential cyanosis may be seen in PDA with
pulmonary hypertension and shunt reversal.
29. How do you differentiate splinter hemorrhages in the
nails due to trauma from that due to small emboli in
infective endocarditis?
Most splinter hemorrhages in the nails are due to
repeated jarring or trauma. Since they are in the nail
substance, they move with the nail as the nail grows and
they extend to the distal nail edge.

Fig. 5: Types of splinter hemorrhages