Cardiovascular examination WASH HANDS!!

Now I am going to examine your cardiovascular system which involves me taking a look at your hands feeling your pulses, having a look at your face, neck and chest and feeling and listening to your heart.I need to expose you to your waist please.

Is that ok with you?

Are you comfortable?Can I have the patients vitals please?

HandsNow I am going to take a look at your hands please.I am looking for,

in palms• pallor in the palmar creases, • palmar erythema,• osler and janeway lesions

in nails • cyanosis, • splinter hemorrhages, • koilonychia, • capillary refill,• nicotine staining, • feeling for any changes in temperature.

I am feeling the radial pulse, ideally for 1 minute. I also want to check both radial pulses at the same time for radio-radial delay. Looking for any petechiae. Ideally I will also palpate for radio-femoral delay.

Do you have any pain in your shoulder?I am going to raise your arm, to check for any collapsing pulse.Ideally I would check the BP now.

FaceGoing to the face, I am looking for

• xanthelasmas around the eyes, • any corneal arcus, and ..• can you look up for me please, any conjunctival pallor. Scleral icterus.• malar flush ( mitral stenosis), • perfusion of the lips,• angular stomatitis, • and can you open your mouth for me please , checking the oro-dental hygiene, looking for

nicotine staining and, can you lift your tongue up for me...looking for any sign of central cyanosis.

Neck• Gong on to the neck I want to look for distended veins and measure the JVP. Please look to your

left side. Using tangential light. Measure it form the sternum.• Check trachea central.• I will feel the carotid pulse after I listen for any carotid bruits.

InspectionI will start with having a look at your chest from the end of the bed.The patient sits comfortably in bed showing some/no signs of shortness of breath or discomfort.Looking for surgical scars, I see no midline sternotomy, inferior clavicular or lateral thoracotomy scars.There are no distended veins, chest wall deformities or visible pulsations around the apex of the heart.

PalpationI will feel your chest now, do you have any pain?

(Feel apex beat note location by counting the spaces.)• Now I will feel for any thrills at the mitral and tricuspid areas. • And also the aortic and pulmonary areas.• Feeling for parasternal heave.

Auscultation• B/L Carotid bruit with the bell. Also palpate the carotid pulses.• Apex: : looking for S1 and S2 and murmurs.• Auscultate apex while palpation of carotid pulses looking for any apical-carotid delay. Please

turn to your left side and I want to auscultate with the bell looking for murmur of mitral stenosis and S3 and S4.

• I will auscultate in the aortic, pulmonary, and tricuspid areas.

Can you sit up and lean forward for me please?( listen in the 2nd intercostal space and down the left sternal border to the apex) looking for murmur of aortic regurgitation.

• Now I will auscultate the bases of the lungs from the back looking for any crackles for pulmonary edema.

• Also looking for sacral edema.• I want palpate the dorsalis pedis, posterior tibial and popliteal pulses.• auscultating for femoral, iliac, aortic bruits, also doing a peripheral vascular examination.

To complete my examination, I will also check • ankle edema, • organomegaly, • abdominal distension.• fundoscopic examination.