Cardiovascular Examination
PREPARATION OF THE PATIENT
1. Greet the patient respectfully and with kindness.
2. Introduce yourself
3. Take a permission
4. Insure privacy
5. Wash your hands
Exposure: to waist
Position: 45 degree
General examination (ABCDE)
General inspection: from the END OF THE BED
Comment on ABCDE:
1. Appearance: looks well/ Unwell, Comfortable/ uncomfortable, Mental state: conscious, oriented to
time, place & person
2. Body built (cachectic, average, underweight, Overweight, obese) tall in Marfan
3. Color (pallor, jaundice, pigmentation, malar flush in MS)
4. Distress (dyspnic tachypnic)
5. Environment (IV lines, drain, oxygen O2 mask, monitor, Defibrillator, pulse oximeter, ECG
Take a vital signs of the patient ( HR, RR, BP, Temp)
From the right side
1. Hands: pallor creases in anemia, hot or cold, janeway, osler in IE Capillary Refill Time CRT
2. Nails: clubbing, splinter hemorrhage in IE
3. Arms: Tattoo, Needles marks.( IE)
4. Pulse:
Rate: if regular 15 s, If irregular 1 min
Rhythm regular or not
Volume: low or high or normal
Character: if present eg. collapsing pulse, Pulsus alternans, slow-rising pulse
check for RR delay in AD and RF delay in Aoric coarctation.
5. Face: malar flush (MS)
Eye: Jaundice, pallor, corneal arcus(lipid), Xanthelasma (lipid), petechial hemorrhage in IE
Mouth: central cyanosis, ulcers, oral hygiene IE , high arched palate Marfan
6. Neck:
JVP Measurement.
7. L.L for edema and scar for saphenous vein harvesting CABG
Precordium exam
INSPECTION:
Look from both ends of the bed
1. Symmetry of the chest
2. Type of breathing: men abdominthoracic, women thoracoabdominal
Look from RT side
Comment upon:
1. Deformity e.g pectus excavatum and carinatum.
2. Scars and describe : name, site, length, old or new healed by1or 2 eg. Midsternotomy scar
3. Visible apical pulsation
4. Pacemaker, hair distribution, skin lesions, dilated veins
PALPATION:
Rules :
Inform the patient what you are going to do
Make sure that your hand is warm
Ask the patient whether there is a painful area
Maintain eye contact with palpation
A. General PALPATION
1. To Gain confidence
2. Superficial Tenderness:
B. Apex Beat
Normally at 5th left ICS midclavicular line
Impalpable in 30 %
Shifted in case of (C O P D)
C. Thrill :
Palpable murmur, Grad more than 3
Palpate same areas of auscultation ( areas of valves)
D. Heave:
Palpate left parasternal area in RVH
AUSCULTAION:
4 Areas
Bell for low pitched sounds and diaphragm for high
Auscultate 4 valves area
Auscultate S1,S2 and if there S3 or S4 or rub or murmurs in each
area
Differentiate S1 from S2 by palpating carotid pulse: S1 comes
before and S2 comes after carotid upstroke
Ask patient to roll onto left side for MS
If murmur present comment on : Site, Time, Grade, intensity,
Radiation
Areas for radiation of murmurs
Carotid for AS
Axilla for MR
Auscultate 2nd Aortic Area (Erbs area)
For AR in sitting position with hold breathing in expiration
Keep the patient in sitting position and Auscultate lung bases and examine back for Sacral edema
Say finally I should complete my examination by
Peripheral vascular examination
Fundoscopy
Abdomen for ascites and liver congestion
