RADIOWQ

Obesity will aggravate, or may entirely account for, breathlessness on exertion. Loss of weight is a common sequel to chronic congestive cardiac failure. It is also a feature hypothyroidism which particularly in the elderly, may readily be overlooked as a cause of heart disease. Skin temperature varies with skin blood flow. In an equable temperature and with normal arteries the skin temperature usually reflects the cardiac output. Thus in low output failure the nose, ears and hands are usually cold; conversely in high output failure they are usually warm. Unduly palms suggest anxiety or thyrotoxicosis. In anxiety the hands are usually cold whereas in thyrotoxicosis they are warm. Clubbing of the fingers occurs in cyanotic congenital heart disease and in advanced bacterial endocrinology, but is more often found in advanced bacterial endocrinology, but is more often found in other conditions, such as intrathoracic suppuration and bronchogenic carcinoma. Flattened, brittle nails (koilonychias) suggest iron deficiency anemia. Splinter hemorrhages under the nails may be present in bacterial endocarditic, as may painful subcutaneous nodules in the fingers or palms.