Cardiovascular Examination

Introduction

Physical Examination

General examination:
- Assess patient's general appearance and level of comfort
- Look for signs of respiratory distress or cyanosis
- Observe for any visible scars or implanted devices (e.g., pacemaker, defibrillator)
Hands
- Examine fingers for clubbing or peripheral cyanosis
- Check capillary refill time in fingers and toes
- Examine for signs of infective endocarditis, such as Osler's nodes, Janeway lesions, or Roth spots in fundoscopy
- Pulse - rate, rhythm, volume, character, equality on both sides, radio-radial and radio femoral delay, collapsing pulse
- Measure blood pressure in both arms, noting any discrepancies
- Evaluate jugular venous pressure (JVP) for signs of heart failure or volume overload
Face
- Eyes: pallor, jaundice, corneal arcus, xanthelasma
- Mouth: Cyanosis, teeth and gums, high arched palate
- Check for ankle oedema or calf tenderness, vein harvesting scar

Precordial Inspection:

Inspect chest for deformities, scars, or visible pulsations
- Scars: midline sternotomy scar, lateral thoracotomy scar, central access, tunnelled line scar, permanent pacemaker/ICD scar, mitral valvotomy scar (lift breast)
- Chest wall deformities: Pectus excavatum. Pectus carinatum

Palpation:

Auscultation:

Listen to heart sounds (S1 and S2) at all cardiac listening areas (aortic, pulmonary, tricuspid, and mitral), noting intensity, splitting, and any additional sounds
Assess for any murmurs, characterising their timing, location, intensity, pitch, and radiation
Listen for any gallops (S3, S4), pericardial rubs, or clicks
Auscultate carotid arteries for bruits, if indicated
With the patient in the sitting position
- Basal crepitations
- Sacral oedema

Complete examination