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CARDIOVASCULAR
SYSTEM
Clinical Examination
Examination Routine
What to do and how to do it.
Important physical signs.
Already covered
Clinical History
Aims
Mini-Lecture
Lunch 12.30-1.30pm
Downs Syndrome.
Exam: General Inspection
Marfans Syndrome.
Myotonic Dystrophy
Exam: General Inspection
Increased Curvature
Cardiovascular
causes of clubbing
can be:
Congenital Cyanotic
Heart Disease
Atrial Myxoma
Endocarditis
Exam: Hands
A sign of systemic
vasculitis which may
indicate Infective
Endocarditis.
Other points to
note:
Temperature
Perfusion
Pallor
Tar staining
Extensor tendon
swellings
(xanthomas)
Exam: Pulse
Start by palpating the
radial pulse.
Volume
?
Character
Exam: Blood Pressure
A single
measurement is
acceptable unless
the history suggests
aortic dissection.
Exam: Head & Neck: FACE
Jaundice
Best seen in
the sclera.
Exam: Head & Neck: FACE
Anaemia
Exam: Head & Neck: FACE
Xanthelasma
Exam: Head & Neck: FACE
Corneal arcus
Exam: Head & Neck: FACE
Central
Cyanosis
Exam: Head & Neck: TEETH
Infective
Endocarditis
Exam: Head & Neck: Carotid Pulses
Sternal Angle
Exam: Head & Neck: JVP
Look
For
Obvious
Deformity
Median Sternotomy
CABG, Valve, Transplant
Congenital disease
Exam: Praecordium
Lateral
Thoracotomy
Coarctation Repair
Exam: Praecordium
Look
For
Obvious
Scars
PPM/ICD
Exam: Praecordium
Intercostal Spaces
Apex Beat
Bell
Diaphragm
Earpiece
2. Sternal Edge:
Tricuspid Valve
BELL
& 3. L 2nd Space:
Pulmonary Valve
DIAPHRAGM
4. R 2nd Space:
Aortic Valve
Exam: Auscultation
Heart Sounds:
LUB DUB
First Second
Mitral Valve Aortic Valve
Tricuspid Valve Pulmonary Valve
SYSTOLIC
Exam: Auscultation
Tricuspid
Regurgitation
First Second
Pulmonary
Stenosis
VSD
First Second
First Second
First Second
Mitral Murmurs
Mitral Area
Patient in Left Lateral
Breath Held in Expiration
Radiate to Axilla
Exam: Auscultation (extras)
Aortic Murmurs
Aortic Area
Sit Patient Forward
Breath Held in Expiration
Radiates to Carotids
Exam: Extra points
Is there anything else you
wish to do ?
Examine the peripheral
pulses.
Check for radio radial or
radio femoral delay.
Listen at the lung bases.
Check for sacral oedema.
Check for peripheral oedema.
Measure the BP if not
already done.
Fundoscopy.
Dipstix Urine.
Summary
Clinical Medicine
Kumar & Clark
Saunders
Examination: The End