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CVS Examination


Introduction
Introduce yourself
Explain what you would like to examine
Gain consent
Place patient at 45° with chest exposed
Ask if patient has any pain anywhere before you begin!
General Inspection
Bedside for treatments or adjuncts – GTN spray, O2, Tablets, Wheelchair, Warfarin
Comfortable at rest?
SOB
Malar Flush
Chest for scars & visible pulsations
Legs for harvest site scars and peripheral oedema
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Hands
Temperature - poor peripheral vasculature
Capillary refill – should be <2 seconds
Colour – cyanosis
Clubbing
Splinter haemorrhages, Jane-way lesions, Oslers Nodes – infective endocarditis
Palmar Erythema – hyperthyroidism, pregnancy, polycythaemia
Nicotine Staining – smoker
 
Pulses
Radial Pulse – rate & rhythm
Radial-Radial Delay – aortic coarctation
Collapsing Pulse – aortic regurgitation
BP – narrow pulse pressure = Aortic Stenosis | wide pulse pressure = Aortic Regurgitation
Carotid – character & volume
JVP – measure and also possibly carry out hepatojugular reflex
 
Face
Eyesconjunctival pallor, jaundice, corneal arcus, xanthelasma
Mouthcentral cyanosis, angular stomatitis
Dental hygiene – infective endocarditis 
 
Close Inspection Of Chest
Scars - lateral thoracotomy (mitral valve), midline sternotomy (CABG), clavicular (pacemaker)
Apex beat – visible in aortic regurgitation and thyrotoxicosis
Chest wall deformities – pectus excavatum, pectus carniatum
 
 
Palpation
Apex beat – 5th intercostal space, mid clavicular
Heaves- left sternal edge – seen in left & right ventricular hypertrophy
Thrills – Palpatable murmurs over aortic valve & apex
 
Auscultation
Listen over 4 valves - ensure palpation of carotid pulse to determine first heart sound
Roll onto left side & listen in mitral areamitral stenosis
Lean forward & listen over aortic area-  aortic regurgitation
Carotids - radiation of aortic stenosis murmurs & bruits
Lung bases – pulmonary oedema
Sacral Oedema & Pedal Oedema
 
To complete the examination
Thank Patient
Wash hands
Summarise Findings
 
 
Say you would
Assess peripheral pulses
Carry out an ECG
Dipstick urine
Bedside Blood Glucose
Fundoscopy
 
source : 
  •  Macleod
  • http://geekymedics.com/osce/cardiovascular-examination-2/
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