Introduction to Cardiovascular Exam
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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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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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