Cardiovascular Examination

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 1

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 2



Wash hands

3