The Cardiovascular Exam

Weight (change), BMI, waist-hip ratio

Pallor, jaundice, cyanosis

Tachycardia, hypotension, dry oral mucosa

Nail bed pallor / cyanosis

Increased soft tissue deposition in distal fingers

Compress the nail, normal if refill in <2 seconds

Splinter haemorrhages, Osler nodes, Janeway lesions

Palmar crease pallor

Lipid nodules on palms, tendons, knees

Indicative of IV drug use

Rate, rhythm, character, postural change

While measuring the heart rate

Radio-radial and (less commonly) radio-femoral delay

Taken surreptitiously whilst measuring pulse

Both arms, sitting / standing

Ask about pain before lifting the patient's shoulder

Abnormal fall >10 systolic BP on inspiration

Mitral facies

Conjunctival pallor, xanthelasma

Hypertensive changes, Roth spots

High-arched palate, central cyanosis, dentition

Palpate individually for contour, amplitude

Auscultate while patient holds breath

Measure (<4cm above sternal angle at 45°)

From trauma or past surgery

Most inferolateral point at which heartbeat clearly palpable

Parasternal heave, thrill

Aortic, pulmonary, tricuspid and mitral areas, axilla

Superficial, scratching sound

Systolic / diastolic / continuous

Grade as 1 (barely audible) to 6 (audible with steth off chest)

Left-sided (expiration), right-sided (inspiration)

S3, mitral stenosis

Aortic & pulmonary murmurs, pericardial rub

Valsalva, squatting

Chest sounds, crackles

Distension, pulsations

Abdominal aorta, hepatosplenomegaly, ascites

Feel with the back of the hand

Elicit subjective pain on palpation

Thin / dry / shiny skin, absence of hair, poor nail growth

Pitting vs. non-pitting - apply pressure for 15 sec

Bruits - aortic, renal, iliac, femoral

Redness, pallor, cyanosis

Increased soft tissue deposition in distal toes

Dilated, tortuous superficial veins

Femoral, popliteal, posterior tibial, dorsalis pedis