Cardiovascular Examination (CVS Examination)

Cardiovascular Examination (CVS Examination)

Peripheral CVS


  • Rate
  • Rhythm
  • Volume
  • Equality
  • 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

Blood pressure

  • 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
  • Arachnodactyly
  • Polydactyly
  • Hypertelorism etc.

Signs of infective endocarditis

Signs of ischemia

  • Asymptomatic
  • Intermittent claudication
  • Pain at rest
  • Tissue loss

Peripheral sign of AR

Signs of thromboembolism

Signs of hyperlipidemia

  • Xanthelasma
  • Xanthema

Features of acute rheumatic fever

Optic fundi

Central CVS

A. Inspection

Precordial bulge

Visible pulsations

Apical impulse

  • Location

Shape of chest

B. Palpation

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°.

Apical impulse

  • Location
  • Character

Left parasternal heave


  • Carotid thrill (Carotid shudder)
  • Aortic thrills
  • Pulmonary thrills
  • Apical thrills


  • Aortic area
  • Pulmonary area
  • Apical area


  • Epigastric
  • Supraclavicular etc.

Tracheal tug

C. Percussion

To be done at

Left border

Right border

Left 2nd intercostal space

Right 2nd intercostal space

Upper part of sternum

Lower part of sternum

D. Auscultation

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).
  • Carotids
  • Inter and infrascapular areas
  • Axilla
  • 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

Heart sounds

  • 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.

Heart Murmurs

  • Site where best heard
  • Systolic or Diastolic
  • Timing
  • Character
  • Grade
  • Pitch (Low or high pitched)
  • Posture in which best heard
  • Conduction
  • 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)

Added sounds

  • S3 heart sound
  • S4 heart sound
  • Opening Snap (OS)
  • Pericardial rub
  • Diastolic knock
  • Tumour plop
  • Prosthetic valve sounds
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