Cardiovascular History and Physical Exam
The cardiovascular history and physical exam is a set of skills well worth mastering early.
- history
- physical
History
The cardiovascular history is an integral aspect of medicine.
Learning about people's signs and symptoms, risk factors, diet and exercise, is important.
Because personal ownership is fundamental to cardiovascular health, cardiovascular literacy, education, and motivation are equally critical.
Physical Exam
Vitals
heart rate, resp rate, blood pressure
Inspection and Palpation
Overall appearance - breathlessness, distress, etc. Body size (obesity, cachexia). Skin temperature, colour, and dryness. Urine output.
Hands and Arms
Clubbing
Cyanosis and capillary refill.
Splinter hemorrhages, Osler's nodes, and Janeway lesions (infective endocarditis).
Radial pulse for rhythm and brachial pulse for volume and contour.
Blood pressure.
Head and Neck
Jugular venous pressure for right heart pressure and volume status.
Carotid pulses for volume, character, and bruits.
Mouth for pallor, cyanosis, and dentition (IE)
Fundi for retinopathy
Face for signs of hyperlipidemia (xanthomas)
Chest
Chest wall, including pectus excivatum, pectus carinatum, or kyphoscoliosis.
Visible pulsations, helpful in directing towards point of maximal impulse (PMI).
Feel for the PMI. Lateral displacement suggests enlarged left ventricle, while downward displacement can occur with COPD. Volume overload causes a brisk apical impulse. Double or triple impulses may be felt, suggesting structural dysfunction.
Feel for thrills, lifts, heaves, and tapping.
Back for sacral edema.
Abdomen
Hepatomegaly
Ascites
Aortic aneurysm
Bruits
Legs
Femoral pulses and radio-femoral delay.
Peripheral pulses
ankle edema
more stigmata of infective endocarditis.
Auscultation
Resources and References
basic cardiovascular exam video (St George's University Clinical Skills Online)