For a detailed walkthrough of the cardiovascular examination, please go to the Cardiovascular Examination OSCE section

INTRODUCTION
  • Wash hands
  • Introduce- My name is…”
  • Consent – “I have been asked to examine your heart, this will involve me having a look and feel of your chest, head and hands. Is that ok?’’
  • Chaperone – mandatory for all female patients
  • Confidentiality
  • Position – 45 degrees,with chest completely bare in males – more discretion for females
INSPECTION  All signs can be found in textbooks, this is just a few to get you started
  • General at end of bed – generally well or not? eg dyspnoea, pain, pallor, sweating, medications
  • Hands – radial pulse (rate and rhythm); collapsing pulse, low volume, bisferiens, alternans. clubbing, splinter haemorrhages, pallor, peripheral cyanosis
  • Face & Neck – pallor, cyanosis, malar flush, xanthelasmata, right carotid (character) – should be in palpation, right internal jugular vein to assess jugular venous pressure.
  • Chest – Scars, abnormal pulsations, pacemaker
  • Blood pressure
Areas for auscultation
(a)    Aortic area : 2nd Intercostal space R. sternal border
(b)   Pulmonary area: 2nd Intercostal space L. sternal border
(c)    Tricuspid, area: 4th Intercostal space lower left sternal edge
(d)   Apex / mitral area: 5th Intercostal space mid-clavicular line
 
PERCUSSION
  • No percussion required of the precordium (should per cuss over posterior chest when concluding the examination)
PALPATION
  • For apex beat  5th intercostal space mid clavicular line– position and character
  • Left parasternal impulse
  • Aortic and pulmonary thrills
  • Right ventricular heave
  • Carotid character – bounding, slow rising, low volume
AUSCULTATION (see diagram) Palpate carotid whilst auscultating to time any murmur
  • Aortic  – listen for aortic stenosis, check for radiation to carotids
  • Pulmonary
  • Tricuspid – sit patient forward with breath held in expiration
  • Aortic regurgitation; use diaphragm to accentuate aortic murmurs
  • Mitral – with patient lying on their left hand side
  • Mitral stenosis, use the bell
  • Mitral regurgitation if suspected move to axilla
  • Right and left carotid for bruits
  • Lung bases
CONCLUSION… ” I  would…”
  • Palpate for ankle /sacral / shin oedema
  • Percussion of posterior chest
  • Pulses – Radio-femoral delay, Peripheral pulses
  • Liver   – Pulsatile?
                  – Assess whether liver is enlarged
  • Cover up and thank patient

For more information, see the cardiovascular examination page

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