Cardiovascular Examination (CVS Examination)
- Character of vessel wall
- Radio-radial delay
- Radio-femoral delay
- Peripheral pulsations (Radial, brachial, dorsalis pedis, posterior tibial, popliteal, femoral, carotid artery)
- Any special character of pulse
- Upper or lower limb
- Supine or standing
Markers of congenital heart disease
- High arched palate
- Radial deformity of forearm
- Low hair line
- Cleft lip
- Cleft palate
- Hypertelorism etc.
Signs of infective endocarditis
Signs of ischemia
- Intermittent claudication
- Pain at rest
- Tissue loss
Peripheral sign of AR
Signs of thromboembolism
Signs of hyperlipidemia
Features of acute rheumatic fever
Shape of chest
The fingertips are used to feel pulsations, the base of fingers for thrills and hand base for heaves. Ideal position is supine or upper trunk elevated to 30°.
Left parasternal heave
- Carotid thrill (Carotid shudder)
- Aortic thrills
- Pulmonary thrills
- Apical thrills
- Aortic area
- Pulmonary area
- Apical area
- Supraclavicular etc.
To be done at
Left 2nd intercostal space
Right 2nd intercostal space
Upper part of sternum
Lower part of sternum
Auscultatory areas are as following:
- Mitral area corresponds to cardiac apex (at 5th left intercostal space near the midclavicular line).
- Tricuspid area corresponds to the lower left parasternal area close to 4th left ICS.
- Aortic area corresponds to the 2nd right intercostal space close to the sternum.
- Pulmonary area corresponds to the 2nd left intercostal space close to the sternum.
- Erb’s area (second aortic area) corresponds to 3rd left intercostal space close to the sternum.
- Gibson’s area corresponds to left first intercostal space close to sternum. PDA murmur is best heard here (Gibson’s murmur).
- Inter and infrascapular areas
- Supra- and infraclavicular areas
Auscultation should proceed in the following manner
- Mitral area > Tricuspid area > Neoaortic area > Pulmonary area > Aortic area
The heart is auscultated for
- 1st heart sound
- 2nd heart sound
- Splitting of heart sounds
- Never comment on the 2nd heart sound in the mitral & tricuspid areas.
- Never comment on the 1st heart sound in the pulmonary & aortic areas.
- Site where best heard
- Systolic or Diastolic
- Pitch (Low or high pitched)
- Posture in which best heard
- Relation of phase of respiration (Variation of the murmur with respiration)
- Whether the murmur is best heard with the bell or the diaphragm of the stethoscope
- Variation of the murmur with dynamic auscultation (manoeuvres, postures, pharmacological agents like amyl nitrite)
- S3 heart sound
- S4 heart sound
- Opening Snap (OS)
- Pericardial rub
- Diastolic knock
- Tumour plop
- Prosthetic valve sounds