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Cardiovascular Examination

The cardiovascular system (CVS) examination is divided into two parts:

  • General physical examination pertaining to the CVS
  • Examination of precordium

General Physical Examination:

a. General demeanor:

  • Dyspnea
  • Distress
  • Body mass
  • Features of Marfan’s and other syndromes

b. Greeting and informed consent

c. Exposure

d. Hands:

1. Dorsum

i.      Clubbing
ii.     Nodes
iii.    Splinter hemorrhages (and other stigmata of infective endocarditis)

2. Palm:

i.      Anemia

ii.      Sweating

iii.      Cyanosis

3. Pulses:

i.      Rate

ii.      Rhythm

iii.      Character (carotid)

iv.      Symmetry (radio-radial and radio-femoral delay)

v.      Volume (carotid)

vi.      Calcification (by rolling the vessel)

vii.      Collapsing pulse

e. Arm:

  • Brachial pulse
  • Blood pressure
  • Temperature

f. Neck:

  1. JVP
  2. Carotids (ONE AT A TIME)
  3. Bruit over carotids

g. Face:

  1. Pallor
  2. Jaundice
  3. Cyanosis
  4. Central
  5. Peripheral
  6. Malar rash
  7. Dental caries
  8. Fundoscopy
  9. Stigmata of hyperthyroidism and hyperlipidemia (Lid lag, lid retraction, exophthalmos, xanthelasmas, tendon xanthomas etc)

h. Precordium (see below)

i. Abdomen:

  1. Hepatomeglay
  2. Ascites
  3. Aortic aneurysm
  4. Bruits (aortic, renal, iliacs etc)
  5. Aortic and Femoral pulse and bruit

j. Legs:

  1. Peripheral pulses (popliteal, posterior tibial and dorsalis pedis)
  2. Edema

k. Back:

  1. Bilateral crepitations
  2. Sacral edema

Examination of Precordium:

If the command is to examine the precordium, then this is performed first, then if time permits general physical examination is conducted.

1. Greetings, introduction, informed consent and exposure:

2. Inspection:

Performed from the side and foot end at the level of the chest.

a. Chest deformaties

b. Scars

c. Incisions

d. Movements

e. Pulsations:

i.      Apex beat

ii.      In pulmonary area

iii.      In suprasternal notch

iv.      In epigastrium

v.      Along the left parasternal border

f. Prominent veins

g. Bulging

3. Palpation:

a. Apex beat

i.      Site (measure with tape)

ii.      Character

  • Left parasternal heave
  • Palpable heart sounds (by placing palm in  ‘  ‑‑‑|___’ pattern over the chest covering all the areas i.e pulmonary area, aortic area, tricuspid area and mitral area)
  • Thrill
  • Palpable pericardial rub

4. Percussion:

Extent of cardiac dullness

5. Auscultation:

  • Heart sounds (timed with carotid pulse)
  • Murmur and radiation
  • Pericardial rub

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