Cardiovascular examination

1. Wash hands
2. Introduce self, identify patient’s name and age
3. I would like to examine your heart; involved looking, feeling and
listening to your chest, is that ok?
4. Any pain at all?
5. Top off; patient at 450

Inspection

1. Patient’s comfort; are you comfortable there?

2. Surrounding: O2 mask, GTN spray, drips, cigarettes, cannula
3. Patient’s appearance
a. Moderately built?
b. Generally well/unwell?
c. Comfortable/distressed?
d. Breathless? Visible pulsations?
e. Pallor? Central cyanosis? Malar flush?
4. Deformities/scars?: Mid sternotomy? Lateral thoracotomy?
Pacemaker?

Hands

1. Warm well-perfused & moist

2. Dorsum: tar staining, splinter haemorrhage, nailfold infarct, clubbing
3. Palmar: peripheral cyanosis, palmar xanthoma, osler nodes, janeway
lesions
4. CRT <2s?

Pulses

1. Radial pulse – rate, rhythm, character

2. Radio-radial delay
3. Collapsing pulse: any pain in shoulder?
4. Brachial pulse
5. BP
6. Carotid pulse

Head and Neck

1. JVP
2. Eyes: conjunctival pallor, corneal arcus, xanthelasma
3. Lips/tongue: central cyanosis? Good dentition?

Chest

1. Palpate apex beat, count intercostal space explicitly: 5th intercostal

space, midclavicular line?
2. Heaves/ thrills?
Auscultation (L thumb on R carotid)

1. Aortic, pulmonary, tricuspid, mitral regions

2. Roll over to the L side, hold expiration, mitral and axilla : mitral
regurg?
3. Sit forward, hold expiration, tricuspid region: aortic regurg?
4. Carotid bruit?

Back

1. Place elbow on your knees

2. Inspect back for any scars, deformities
3. Percuss lungs
4. Auscultate for bibasal crackles
5. Palpate for sacral oedema

Peripheries

1. Peripheral oedema on medial malleolus.

Completion

1. Peripheral pulses
2. Fundoscopy
3. Dipstick urine
4. Observation chart
5. ECG

Thank patient, cover patient, wash hands.

Summarise

1. Name, gender, age

2. On CVS examination he/she was generally well?
3. Chest appeared normal with no scars
4. No peripheral stigmata of CVS diseases
5. Radial pulse:
6. No mediastinal shift
7. Normal heart sounds with no added sounds
8. No pulmonary/peripheral oedema