Cardiovascular system examination
General examination
- Level of consciousness- Alert/ Oriented/ cooperative
- Decubitus (position in bed)
- Gait
- Built- Average/ small or large for age
- Nutrition- Average/ undernutrition
- Any obvious dysmorphism
- Respiration effort- rate, rhythm, pattern, depth, laboured or not
Face
- Dysmorphism
- Cyanosis/ Pallor
- Respiratory distress- nasal cannula/ nasal flaring
Cardiovascular system examination involves 2 systems- peripheral and central cardiovascular systems
Start from the periphery and then come to the central .
Peripheral system
- Pulse
- Rate
- Rhythm
- Volume
- Radial comparison of both hands
- Radio femoral delay
- Any special character
- Examination of neck veins
- Raised JVP
Central CVS
Inspection
Precordium
- Shape- any deformity
- Pulsation- see in these areas
- Apical impulse
- Aortic area
- Pulmonary area
- Parasternal area
- Suprasternal area
- Carotid pulsation
- Engorged superficial veins
- Scars
Inspect back for
- Scoliosis
- Kyphosis
- Scars
- Winging of scapula
Palpation
Mitral area (Apex beat)
- Site
- Character
- Palpable heart sound
- Thrill
Tricuspid area
- Left parasternal heave
- Palpable heart sound
- Thrill
Aortic area
- Pulsation
- Palpable heart sound
- Thrill
Pulmonary area
- Pulsation
- Palpable heart sound
- Thrill
Thrill in carotid area
Direction of blood flow in engorged superficial veins
Percussion- not done
Auscultation- Done in all 4 areas- Mitral/ Tricuspid/ Aortic/ Pulmonary
- Heart rate-
- Normal for age?
- Rhythm-
- Regular/ Irregular? Listen for a full minute
- Murmur-
- Present or absent?
- Systolic or Diastolic?
- Other sounds-
- Opening snap/ ejection click
- Splitting of heart sounds
- S3 and S4 if heard
Auscultate over carotid areas