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Cardiovascular Examination

A 14-step cardiovascular examination, including comments on findings.

Cardiology · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Obtain consent

    Obtain consent

  5. Position and exposure

    Position patient and expose as necessary

Step 2. General Inspection

  1. Posture and comfort

    Posture/comfort

  2. Body habitus

    Body habitus

  3. Colour

    Colour

  4. Respiratory distress

    Respiratory distress

  5. Dysmorphic features

    Dysmorphic features

  6. Bedside chart

    Check bedside chart (obs/vitals)

Step 3. Hands and Upper Limb

  1. Palmar crease pallor

    Palmar crease pallor

  2. Peripheral cyanosis

    Peripheral cyanosis

  3. Clubbing

    Clubbing

  4. Xanthomata

    Xanthomata

  5. Signs of infective endocarditis

    Signs of infective endocarditis (splinter haemorrhages, Osler nodes, Janeway lesions)

Step 4. Perform Vital Signs

  1. Radial pulse

    Radial pulse (rate, rhythm)

  2. Respiratory rate

    Respiratory rate

  3. Radio-radial delay

    Radio-radial delay

  4. Radio-femoral delay

    Knowledge of radio-femoral delay

  5. Blood pressure measurement

    Knowledge of blood pressure measurement

  6. Comment

    Students should comment on, but are not required to perform, BP and radio-femoral delay.

Step 5. Face – Eyes and Mouth

  1. Eyes

    Eyes: xanthelasma, conjunctival pallor, jaundice

  2. Mouth — comment only

    Comment on mouth exam: central cyanosis, palate, teeth, gums

  3. Comment

    Students should comment on but not perform examination of the mouth.

Step 6. Neck

  1. JVP

    JVP (patient correctly positioned, measurement accuracy, appropriately reported)

  2. Carotid pulse

    Carotid pulse

  3. Carotid bruits

    Carotid bruits

Step 7. Chest Inspection

  1. Shape and deformities

    Shape/deformities

  2. Implantable devices

    Implantable devices

  3. Scars

    Scars

  4. Apex beat

    Apex beat (visible/not visible)

Step 8. Palpation of Chest

  1. Apex beat

    Apex beat (position and character)

  2. Thrills

    Thrills (valve areas)

  3. Heaves

    Heaves (parasternal/apex)

Step 9. Auscultation of Chest

  1. Mitral/apex

    Mitral/apex (bell and diaphragm)

  2. Tricuspid

    Tricuspid

  3. Left sternal margin

    Left sternal margin

  4. Pulmonary

    Pulmonary

  5. Aortic

    Aortic

Step 10. Further Auscultation of Chest

  1. Left lateral

    Left lateral: apex beat, mitral (bell)

  2. Leaning forward

    Leaning forward, in expiration: aortic ± left sternal margin

Step 11. Back

  1. Posterior chest

    Inspection of posterior chest

  2. Sacral oedema

    Palpation for sacral oedema

  3. Percussion

    Percussion of lung bases

  4. Auscultation

    Auscultation of lung bases

Step 12. Lower Limbs

  1. Inspection

    Inspect: varicose veins, colour and temperature of legs, trophic changes, ulceration, clubbing (toes), xanthomata

  2. Palpation

    Palpate: oedema, calf tenderness, peripheral pulses (excluding femoral pulse)

Step 13. Abdomen

  1. Comment

    Students should mention, but not perform, what they would seek on abdominal examination.

  2. Palpation — describe only

    Palpate for tenderness, masses, organomegaly, aortic aneurysm

  3. Percussion — describe only

    Percuss for ascites

  4. Auscultation — describe only

    Auscultate for bruits

Step 14. Conclusion

  1. Thank the patient

    Thank patient and indicate they may redress

  2. Hand hygiene

    Hand rub/hand wash

  3. Bedside tests

    Comment on bedside tests, e.g. ECG, fundoscopy, urinalysis

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