Cardiovascular Examination

CARDIAC EXAMINATION INSPECTION: • • • • • • •

Peripheral cyanosis koilonychia Finger clubbing Splinter haemorrhages Nicotine staining Edema__ Note

PALPATION •

Pulses o Radial pulse  

Rate Rhythm • • • • • •

Regular Regularly irregular Irregularly irregular Collapsing pulse Equal pulse Unequal pulse

o Carotid pulse  Volume • Normal • Increased • Decreased  Upstroke • Normal • Delayed • Brisk  Character • Anacrotic pulse • Fall away quickly • Collapsing pulse • Single beating

•

Twice beating

o Jugular venous pulse • • • • • • • • • • • • • • •

Normal Increased Decreased No change to prior visit Dominant a wave Cannon a wave Dominant v wave Absent x descent Exaggerated x descent Sharp y descent Slow y descent Regular Abdominojugular reflux Pulsatile liver Notes

o Femoral pulse • •

Radial femoral delay present/absent Grade o 0=absent o 1=diminished o 2=normal o 3=increased o 4=bounding o Dorsalis Pedis pulse o 0=absent o 1=diminished o 2=normal o 3=increased o 4=bounding o The posterior Tibial pulse o 0=absent o 1=diminished o 2=normal o 3=increased

o 4=bounding

o APEX BEAT • • •

•

•

• •

Normal Absent Shifted to o Right o Left Shifted o With trachea o With out trachea Intensity o Normal o Double impulse o Dyskinetic o Hyperdynamic o Hyperkinetic o Tapping apex Palpable Notes

AUSCULTATION •

S1 o Soft o Loud

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•

• • •

S2 o Soft o Loud  Aortic  Pulmonary Splitting o Increased o Fixed S3 S4 Murmurs o Intensity  I/VI  II/VI  III/VI  IV/VI

o o

o

o

o

o o o o o

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 V/VI  VI/VI Duration ____ Timing  Systolic  Diastolic Quality  Ejection murmurs  Constant intensity murmurs  Musical  Blowing  Harsh  Rumbling Pitch  High  Medium  Low Location ____  LUSB  LLSB  RSB Radiation_____ Relationship to respiration inspiration/expiration Relationship to position____ Other associated sounds___ Notes  Midsystolic murmur  Pansystolic (or holosystolic) murmur  Late systolic murmur  Early diastolic murmur  Middiastolic murmur  Late diastolic (or presystolic) murmur  Continuous murmur  Crescendo murmur  Decrescendo murmur  Crescendo-decrescendo murmur

Rhythm o Regular o Irregular o Regularly irregular o Irregularly irregular

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Friction Rub o Present o Absent