1. Introduction
The cardiovascular examination is used to identify valvular disease, heart failure, arrhythmia, infective endocarditis and congenital or acquired cardiovascular pathology. A structured approach helps you detect peripheral signs and interpret cardiac findings correctly.
2. Preparation and general inspection
Wash your hands, introduce yourself, confirm the patient''s identity and explain the examination. Position the patient at 45 degrees and expose the chest appropriately while maintaining dignity. Inspect from the end of the bed for breathlessness, cachexia, scars, oxygen therapy, medication infusions or obvious discomfort.
3. Hands, pulse and face
Inspect the hands for clubbing, splinter haemorrhages, peripheral cyanosis, xanthomata and signs of infective endocarditis such as Osler nodes and Janeway lesions. Palpate the radial pulse for rate and rhythm. Assess collapsing character if aortic regurgitation is suspected and compare radial pulses if indicated. Inspect the eyes and mouth for conjunctival pallor, corneal arcus, xanthelasma, central cyanosis and high arched palate or poor dentition where relevant.
4. Neck and precordium
Assess the jugular venous pressure with the patient reclined at 45 degrees. Palpate the carotid pulse one side at a time and assess character if appropriate. Inspect the precordium for scars, deformity and visible pulsations. Palpate the apex beat and assess its site and character, then feel for parasternal heave and thrills.
5. Auscultation
Auscultate in the aortic, pulmonary, tricuspid and mitral areas using both diaphragm and bell where appropriate. Assess heart sounds and identify murmurs by timing, pitch, radiation and any manoeuvres that change them. Listen in the carotids for radiation of aortic stenosis and at the apex in the left lateral position for the low pitched murmur of mitral stenosis. Sit the patient forward in expiration to listen for aortic regurgitation.
6. Completion
To complete the examination, check for peripheral oedema, inspect the sacrum in a bedbound patient, auscultate the lung bases for crackles and measure the blood pressure in both arms if indicated. Summarise the findings and suggest appropriate investigations such as ECG and echocardiography.
Preparation
General inspection
Hands
Face
Neck
Precordium
Auscultation
Completion