Introduction to Cardiovascular Exam

This article provides a brief overview of the cardiovascular examination. For a detailed walkthrough please go to the Cardiovascular Examination OSCE article.

• 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

• 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 : 2^nd Intercostal space R. sternal border
(b)Pulmonary area: 2^nd Intercostal space L. sternal border
(c)Tricuspid, area: 4^th Intercostal space lower left sternal edge
(d)Apex / mitral area: 5^th 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  5^th 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