| Cardiovascular | Pulmonary | Endocrine | Autoimmune | Mood disorders | Sleep disorders |
Common symptoms and signs | Symptoms: | Symptoms: | Symptoms: | Symptoms: | Symptoms: | Symptoms: |
- Chest pains, palpitations, sweating, nausea, fatigue, leg swelling, shortness of breath - at rest/on exertion/lying flat/waking up at night, dizziness on standing, feeling faint/fainting
| - Shortness of breath - at rest/on exertion, cough, wheeze, fatigue, poor activity tolerance
| - Palpitations, fatigue, dizziness, weight gain/loss, sense of chills/fever, irregular menstrual cycle, poor diabetic control, excessive thirst/urination
| - Rash, joint/muscle pain and stiffness, fever, mouth sores/ulcers, cold/pale/blue/red fingers, sharp chest pain, numbness/tingling/burning in fingers/toes, blurry/decreased vision
| - Anxiety, irritability, chest tightness, low frustration tolerance, depression, fatigue, mood swings, palpitations, change in memory/recall
| - Poor sleep - hard to fall asleep/wakes frequently/wakes early, nonrestorative/refreshing sleep - "tired" on waking, snoring, frequent urination at night, bad dreams/nightmares, falls asleep during the day, morning headaches
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Signs: | Signs: | Signs: | Signs: | Signs: | Signs: |
- Pallor, tachypnea, tachycardia, diaphoresis, pulmonary rales, lower extremity edema, hypotensive sitting/standing - orthostatic hypotension, presyncopal/syncopal, poor activity tolerance/endurance
| - Tachypnea, tachycardia, cough, hypoxia/low pulse oximeter, pulmonary wheezes/rhonchi/"Velcro" rales, poor activity tolerance/endurance
| - Tachycardia, poor activity tolerance, weight gain/loss, low/elevated temperature, elevated fingerstick/urine glucose, ketotic (fruity) breath
| - Rash, arthropathy - swelling/warmth/decreased ROM, myopathy - tenderness/weakness, fever, Raynaud phenomena, pleuritic pain on deep breathing, altered sensation, decreased visual acuity
| - Flat affect/low mood, emotional lability that is, crying/laughing inappropriately, limited impulse control, psychosis
| - Snoring, restless legs, observed apneic episodes, hypertension, arrhythmias, narcolepsy, congestive heart failure, impaired neurocognition, poorly controlled mood disorder
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Further studies to consider in addition to basic laboratory evaluation | BNP, troponins, D-dimer, CXR, EKG, ECHO, EST/CPET, Holter monitor, cardiac magnetic resonance imaging | D-dimer, PFTs, CXR, CT chest (with contrast if concerned for a pulmonary embolism) | TSH/thyroxine, cortisol levels, growth hormone, LH, FSH, testosterone (men), estradiol (women) | Imaging of affected joints, antibody screen based on ongoing symptoms | An anxiety and depression screen (for example, HADS, BDI fast screen; PHQ-2/9, GDS | Sleep apnea screen (eg, the STOP-Bang questionnaire or ESS) overnight sleep study for oximetry and sleep apnea |
Referral | Cardiology | Pulmonology | Endocrinology | Rheumatology | Psychiatry | Sleep medicine |