Cardiovascular examination
● Introduce yourself, permission, privacy, temperature, lighting
● Patient’s position: lying at 450
● Exposure: thorax
General exam
● Comment at the patient’s appearance (looks well, unwell, distressed), signs
of respiratory distress
● V/S including temperature, pulse, BP, RR
❖ Hands: -feel the temperature
-check capillary refill time: NL<2 sec
-peripheral cyanosis, tar stain, pallor, petechial rash, splinter
hemorrhages (normal up to 2), clubbing
-extensor surface for xanthomata
-palmar surface for Janeway lesions and Osler’s nodes
✔ Pulses: radial, brachial, carotid. Comment on rate & rhythm (from radial
pulse), volume & character (from carotid or brachial)
✔ Check for collapsing pulse, radiofemoral delay, check both radial pulses
simultaneously for any delay
✔ Auscultate the carotids for bruit
❖ Face: -central cyanosis
-pallor
-xanthelasma
-corneal arcus
-Fundoscopy (for hypertensive retinal changes, Roth spots)
❖ JVP
❖ Precordium:
✔ Inspection: -chest deformities, scars, visible pulsation
✔ Palpation: -locate the apex beat (you may ask the patient to roll on to his
left side if you couldn’t feel it). Note its character.
-palpate for RV heave in left parasternal edge while the patient
holds breath in expiration
-palpate for thrill over apex & both sides of sternum
✔ Auscultation: -using diaphragm: at the apex, lower left sternal border,
upper right & left sternal borders, carotids while patient holds breath, left
axilla
-using bell: at the apex & lower left sternal border. Roll the
patient to his left side and auscultate the apex.
-ask the patient to sit up and lean forward, listen over left
parasternal area & right 2nd intercostal space with the diaphragm while the
patient holds his breath after full expiration
** comment on heart sounds (S1& S2: normal, loud, soft), presence of any
added sounds
** in case you hear a murmur, determine its timing (whether it is systolic or
diastolic) using the patient’s carotid pulse. Also comment on its duration,
pitch, character, intensity, location and radiation.