The physical examination is a cornerstone of good geriatric medicine.

Physical examination of elderly patients with congestive heart failure differs little from that of younger patients. An important aspect of conducting an examination on an older patient with heart failure is listening to heart and chest sounds.

• Physical Exam Tip

Classic physical findings of congestive heart failure include the following:

Vital signs:

• Tachypnea
• Cheyne-Stokes Respiration

Heart:

• S3 Gallop
• Normal Heart Sounds

Neck:

• Jugular venous distention
• Hepato-jugular reflux

Chest:

• Bibasilar rales
• Diffuse bubbling rales of pulmonary edema
• Wheezing (cardiac asthma)
• Signs of pleural effusion (flatness to percussion, decreased to absent breath sounds, inspiratory lag)

Abdomen, back and extremities:

• Large, tender liver
• Acites
• Sacral edema
• Peripheral edema