CARDIVASCULAR PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

Introduction:

1 Wash your hands and don PPE if appropriate

2 Introduce yourself to the patient including your name and role

3 Confirm the patient's name and date of birth

4 Briefly explain what the examination will involve using patient-friendly language

5 Gain consent to proceed with the examination

6 Adjust the head of the bed to a 45° angle

General inspection

1. Inspect for clinical signs suggestive of underlying pathology (e.g. cyanosis,

shortness of breath, pallor)
2. Look for objects or equipment on or around the patient (e.g. walking aids,
medical equipment)

Hands

 Inspect the hands (color, tar staining, xanthomata, finger clubbing)

 Assess and compare the temperature of the hands
 Assess capillary refill time (CRT)
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Pulses and blood pressure

 Palpate the radial pulse, assessing the heart rate and rhythm
 Assess for radio-radial delay
 Assess for a collapsing pulse
 Palpate the brachial pulse, assessing volume and character
 Offer to measure the patient’s blood pressure in both arms
 Auscultate the carotid pulse
 Palpate the carotid pulse

Jugular venous pressure (JVP)

 Measure the JVP with the patient positioned correctly

 Elicit hepatojugular reflux if appropriate

Face

 Inspect the eyes for signs relevant to the cardiovascular system (e.g. conjunctival
pallor,
 corneal arcus, xanthelasma)
 Inspect the mouth for signs relevant to the cardiovascular system (e.g. central
cyanosis,
 angular stomatitis, high-arched palate, dental hygiene)

inspection of the chest

 Inspect for scars, Inspect for scars, chest wall deformities and pulsations

Palpation

 Palpate the apex beat and assess position

 Assess for a parasternal heave
 Assess for thrills

Auscultation
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 Auscultate the mitral, tricuspid, pulmonary and aortic valve with the diaphragm of the
stethoscope, whilst palpating the carotid pulse.
 Repeat auscultation of all 4 valves using the bell of the stethoscope’s

Final steps

 Inspect the posterior chest wall for any deformities or scars

 Auscultate the posterior lung fields you can do or you can skip
 Palpate for sacral edema
 Palpate the patient’s ankles for evidence of pitting edema
 Inspect the patient’s legs for evidence of saphenous vein harvesting sites

To complete the examination

 Explain that the examination is now finished to the patient

 41 Thank the patient for their time
 42 Dispose of PPE appropriately and wash your hands
 43 Summaries your findings

Example summary

“Today I examined (name of the patient ,age, male or female.

CARDIVASCULAR PHYSICAL EXAMINATION
On general inspection, the patient appeared comfortable at rest and there were no
objects or medical equipment around the bed of relevance.”

“The hands had no peripheral stigmata of cardiovascular disease and were

symmetrically warm, with a normal capillary refill time.”

“The pulse was regular and there was no radio-radial delay. On auscultation of the
carotid arteries, there was no evidence of carotid bruits and on palpation, the carotid
pulse had normal volume and character.”

“On inspection of the face, there were no stigmata of cardiovascular disease noted in
the eyes or mouth and dentition was normal.”

“Assessment of the JVP did not reveal any abnormalities and the hepatojugular reflux
test was negative.”

“Closer inspection of the chest did not reveal any scars or chest wall abnormalities. The
apex beat was palpable in the 5th intercostal space, in the mid-clavicular line. No heaves
or thrills were noted.”

“Auscultation of the precordium revealed normal heart sounds, with no added sounds.”

“There was no evidence of peripheral edema and lung fields were clear on
auscultation.”

“In summary, these findings are consistent with a normal cardiovascular examination.”