cardiovascular examination

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follow these steps in CVS examination:

Introduction : Hello Mr Smith,

My name is Dr X ; I'm a medical SHO,

Can I examine your heart please?

Position : 45 degree

Is it sore anywhere?

Exposure: can you take your shirt please?

General inspection : stand back,

Ask the patient to take deep breath in,

Look is he comfortable at rest, is he SOB?

Look for catheter, peripheral oedema, GTN, OXYGEN,

Malar rash,Lip cyanosis, BP apparatus.

Hands : look for warm/cold

Clubbing

Splinter haemorrhage

Xanthoma

Tobacco staining

Arm: pulse (rate, rhythm, volume, character & synchronous) Radio-radial delay

Collapsing pulse (ask for pain in shoulder)

Radio-femoral delay

Brachial pulse & anti cubital fosaa scar.

Feel carotid pulse & comment on character.

Face:

eyes for paller, xanthlasma

Mouth for tongue, cyanosis

JVP

Inspection:

Comment on mid sternal scar/ mitral valvotomy scar.

Palpation:

Palpate for apex beat (count the apex beat from sternal angle.

comment on position and character? tapping/heaving/normal)

Palpate for heave on either side of sternum

Palpate for thrill in 2 ICS

Auscultation:

Start from the apex. Comment on s1-s2

Always sync with carotid pulse and also ask pts to breath

in and out to look for respiratory variable

If PSM of MR then radiate to axilla

If EDM of MS (if u cant here murmur then L lateral position with bell)

PALPATE APEX BEFORE AUSCULTATE.

If ESM of AS auscultate in apex, below sternum,

left 2^nd ICS, right 2^nd ICS, then to carotid pulse.

Comment on site of best audible.

If EDM ofAR auscultate in right 2^nd with pts leaning

forward with breath held in expiration.

when finished,

Thank the pt

Conclude by saying:

I would like to finish ex by

checking signs of heart failure

(auscultating lung bases, looking for hepatomegaly, pedal oedema and sacral oedema).

Checking BP.

Checking urine