Lesson 5.2: Cardiovascular Examination
Patient position: sitting at 45 degrees, chest exposed, legs visible for oedema. Work from periphery to centre following IPPA.
Technique Checklist
- General inspection — distress, breathlessness, pallor, cyanosis, malar flush
- Hands — clubbing, splinter haemorrhages, peripheral cyanosis
- Radial pulse — rate, rhythm, character, radio-radial delay
- Blood pressure (both arms if aortic dissection suspected)
- Face — xanthelasma, corneal arcus, conjunctival pallor, central cyanosis (tongue)
- Neck — JVP height and waveform; carotid pulse character
- Praecordium inspection — scars (sternotomy, pacemaker), deformity, visible pulsations
- Apex beat — location (normal: 5th ICS midclavicular line) and character
- Heaves and thrills — left parasternal heave; palpable thrills over valve areas
- Auscultation — all four areas: mitral, tricuspid, pulmonary, aortic (MTPA)
- Manoeuvres — lean forward/hold breath (aortic regurgitation); left lateral decubitus (mitral stenosis)
- Lung bases — bibasal crackles suggest pulmonary oedema
- Sacral and ankle oedema — pitting, bilateral
- Peripheral pulses — pedal pulses if peripheral vascular disease is suspected
- Bedside: ECG, oxygen saturation (say these aloud)
When Cardiac Findings Are Handed to You
When the examiner hands you a card describing heart sounds or additional signs, interpret and present clearly:
- Murmur: State the timing (systolic/diastolic), character, where it is loudest, and any radiation. Then state the most likely cause and what you would do next: 'This sounds most consistent with [condition]. I would like to arrange an echocardiogram.'
- Heart failure signs (raised JVP, bibasal crackles, oedema, displaced apex beat): State what you have found, say the findings are consistent with heart failure, and propose next steps: 'I would like an ECG, chest X-ray, BNP, and to discuss this with my senior.'
- Irregular pulse: 'The pulse is irregularly irregular — this is consistent with atrial fibrillation. I would like to perform an ECG to confirm this.'
Detailed clinical knowledge of specific murmurs and cardiac conditions is covered in the clinical case modules. Here, focus on demonstrating the correct technique and presenting findings you are given confidently and in plain language.