General examination of a pt with suspected heart disease should include vital signs (respiratory rate, pulse, blood pressure) and observation of skin color (e.g., cyanosis, pallor, jaundice), clubbing, edema, evidence of decreased perfusion (cool and diaphoretic skin), and hypertensive changes in optic fundi. Examine abdomen for evidence of hepatomegaly, ascites, or abdominal aortic aneurysm. An ankle-brachial index (systolic bp at ankle divided by arm systolic bp) <0.9 indicates lower extremity arterial obstructive disease. Important findings on cardiovascular examination include: