Cardiovascular examination

Introduction:
 Introduce yourself
 Ask patients name, age, DOB, check wristband
 Gain consent.

General Examination
 Does the patient look unwell? Conscious?
 Frightened/ distressed?
 Look for signs of alcohol abuse

End of bed examination

 Look around the bed (for breathing equipment, heart monitor,
GTN spray, IV access, cigarettes, ECG, mobility assistance)
 Observe the patient
 Look for
o Scars
o Colour
o Breathing
o Comfort
o Position
o Build
o Deformities
o Wasting

Hand examination
 General
o Colour
o Temperature
o Capillary refill time
 Fingers
o Clubbing
o Splinter haemorrhages
o Nicotine stains
o Koilonychia
 Palm and dorsum of the hand
o Palmar creases
o Osler’s nodes
o Janeway lesions
o Tendon xanthoma
o Palmar xanthoma

Arm
 Radial pulse (rate, rhythm, volume)
 Collapsing pulse (ask the patient if they have any pain in their
arm)
 Compare Radio-radial delay.
 Brachial pulse (medial to the tendon of the bicep)
 Blood pressure

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Face
 Conjunctiva
 Sclera
 Corneal arcus
 Xanthelasma
 Malar flush
 Mouth- check tongue for cyanosis, dentition.
 Syndrome problems e.g. downs, marfan’s

Neck
 Carotid pulses (character and volume)
 Listen for bruits over both carotids, whilst the patient holds their
breath
 JVP

Chest inspection
 Visible pulsation/ heaves
 Scars
 Dilated veins
 Abnormalities
 Masses
 Pulsations

Chest Palpation
 Feel for apex beat
 Feel for heaves, each area
 Thrills, check in each area
 Feel the right ventricle with heel of hand in the left para-sternal
position, ask patient to hold their breath,

Chest Auscultation
 Using diaphragm and then the bell
o Apex
 Roll the patient to the left and listen for mitral
stenosis
 Check timing with the carotid
o Aortic area
o Pulmonary area
o Tricuspid area (check again with patient holding in
breath- aortic regurgitation)
o Sit the patient up and forward and ask them to breathe
out fully and hold his breath

Extras
 Check for hepatomegaly and pulsatility of the liver
 Check for femoral pulses, femoro-radial delay
 Check for pitting oedema at ankles and pedal pulses

Ending
 Thank the patient

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 Wash hands