Cardiovascular examination

Overall (holistic) impression

• cachexia
• breathless
• cyanosis

Hands

• • peripheral cyanosis
  • finger clubbing
  • splinter haemorrhages
  • capillary refill time
  • palmar crease pallor vs. palmar erythema
  • pulse
    • rhythm
    • rate ± character
    • radio-radial (lift arm) or radio-femoral delay

Neck

• brachial and carotid pulse
• JVP
• thyroid
• blood pressure
• body temperature

Face

• eyes
  • pallor
  • jaundice
  • xanthelasma
• mouth
  • central cyanosis

Praecordial Examination

Inspection

Palpation

• apex beat
• heaves
• thrills

Auscultation

• all four areas
• heart sounds, added sounds
• murmurs – timing, intensity, etc.
• ± dynamic manoeuvres
  • valsalva: reduces preload
    • systolic murmur gets louder ⇒ HOCM
      • cf. mitral regurgitation and aortic stenosis murmurs (get softer)
  • squatting: increases preload
    • systolic murmur gets louder ⇒ aortic stenosis and then softer on standing
      • cf. HOCM murmur (gets softer on squatting)

Liver: hepatomegaly [percussion and palpation], pulsatile (spleen / ascites)

Lungs: bibasal crepitations [percussion and auscultation]

Legs: ankle oedema, peripheral vascular disease