General Observation CVS

Sequence of Cardiovascular Examination

General observations -

Breathless at rest, cyanosis

1. Hands - Temperature, peripheral cyanosis, splinter haemorrhages, tar staining, xanthomata

2. Radial pulse - Rate, rhythm, collapsing

3. Arm - Blood pressure, brachial pulse waveform

4. Eyes - Arcus, xanthelasma, anaemia

5. Face - Malar flush

6. Lips and tongue - Central cyanosis

7. Neck - JVP, carotid pulse

8. Chest-Inspection - Scars, pulsations Palpation - Apex, thrils, heaves-Auscultation - Heart sounds, added sounds, murmurs, carotid bruits, basal crepitations

   Other - Radiofemoral synchrony, peripheral pulses, oedema, pulsatile liver, urinalysis

So proceed in an orderly fashion:

1. • General Examination (Related one)  Always proceed in an orderly fashion  Follow these steps when examining the heart
     • Inspect
     • Palpate
     • Auscultate
2. • Blood vessel exam
3. • Heart Examination (Note: Percussion is omitted when examining the heart.

• Vital Signs - Note BP (both arms), T, RR, HR, 02, pain level
• General - Note patient’s general appearance
• Signs of heart failure in other organs (lungs, liver, lower limbs)
• Fundus examination (arterial changes, haemorrhages, exudates and paliloedema) in arterial hypertension

Precordium

1. Inspection CVS
2. Palpation CVS
3. Percussion - not routinely done
4. Auscultation CVS
   • -Back
   • -Abdomen
   • -Lower limbs

General

• Hands

• Pulse

• Blood pressure

• Face

• Neck

• Jugular venous pressure

  General Examination

• Position patient at 45 degrees

• General appearance: body built: obese, Cachexia

• Marfan’s syndrome

• Down’s syndrome

Examination of eyes

• xanthelasma
• CORNEAL Arcus
• Roth spot