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Introduce yourself Explain what you would like to examine Gain consent Place patient at 45 with chest exposed Ask if patient has any pain anywhere before you begin!

General Inspection
Bedside for treatments or adjuncts GTN spray, O2, Tablets, Wheelchair, Warfarin Comfortable at rest? SOB Malar Flush Chest for scars & visible pulsations Legs for harvest site scars and peripheral oedema

Temperature - poor peripheral vasculature

Capillary refill should be <2 seconds Colour cyanosis Clubbing Splinter haemorrhages, Jane-way lesions, Oslers Nodes infective endocarditis Palmar Erythema hyperthyroidism, pregnancy, polycythaemia Nicotine Staining smoker

Radial Pulse rate & rhythm Radial-Radial Delay aortic coarctation Collapsing Pulse aortic regurgitation

BP narrow pulse pressure = Aortic Stenosis | wide pulse pressure = Aortic Regurgitation Carotid character & volume JVP measure and also possibly carry out hepatojugular reflex

Eyes conjunctival pallor, jaundice, corneal arcus, xanthelasma

Mouth central cyanosis, angular stomatitis Dental hygiene infective endocarditis

Close Inspection Of Chest

Scars - lateral thoracotomy (mitral valve), midline sternotomy (CABG), clavicular (pacemaker) Apex beat visible in aortic regurgitation and thyrotoxicosis Chest wall deformities pectus excavatum, pectus carniatum

Apex beat 5th intercostal space, mid clavicular Heaves- left sternal edge seen in left & right ventricular hypertrophy Thrills Palpatable murmurs over aortic valve & apex

Listen over 4 valves - ensure palpation of carotid pulse to determine first heart sound Roll onto left side & listen in mitral area mitral stenosis Lean forward & listen over aortic area- aortic regurgitation Carotids - radiation of aortic stenosis murmurs & bruits Lung bases pulmonary oedema Sacral Oedema & Pedal Oedema

To complete the examination

Thank Patient Wash hands Summarise Findings Say you would Assess peripheral pulses Carry out an ECG Dipstick urine Bedside Blood Glucose Fundoscopy
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