Cardiovascular
System Examination
Approach
General Observation
§ Look at the surroundings
§ Things connected to the patients
§ Observe any sounds “Prosthetic valve?”
§ Well or unwell (conscious, toxic, pain, …)
§ Respiratory distress: Count the RR “10Sec.X
6”
§ Growth & nutritional status
§ Dysmorphic features & Face
§ Colors (Cyanosis,
Pallor, Jaundice)
Hand
§ Clubbing (Test if in doubt) Examine the clubbing if present
(angel, curvature, fluctuation & degree).
§ Cyanosis (Cold hand)
§ Pallor (Compare pt.’s hand with yours)
§ Perfusion (Capillary refill)
§ Pulse (Equality, rate, volume, character. Femoral “leave to the
end)
§ BP (at the end)
§ Others (Hand anomaly, stigmata
of Endocarditis & Xanthoma ..)
Head
§ Pallor & Cyanosis
(Stick your tongue out)
§ Comment on Teeth
§ Sings of respiratory distress (Grunting
& working Ala nasai)
Neck
§ Neck veins (Turn neck to your side & look to the
other side)
§ Thrill (Suprasternal “Inform the child” & supraclavicular
“Neck”)
Inspection chest
§ Scars (Raise arms up)
§ Precordial bulge
§ Visible pulsations
§ Dilated veins
Palpation chest
§ Apex (Both hands on the chest then, count the rib spaces &
point the apex)
§ Thrill (in 4 areas & timing)
§ Parasternal heave (lift)
§ Palpable heart sound
Percussion chest
§ Upper border
of the liver (if there
is hepatomegaly)
Auscultation
§ Front basic 4 & total 6 areas (apex, Lt. LSB, Lt. Middle SB, Lt.USB,
Rt. USB & Axillae) (Use the
Bell for apex only & diaphragm for other areas)
§ Back "Below & in between scapula"
§ Change patient’s
position
§ Lung bases for crackles
§ Comment (Heart sounds, splitting S2, added sounds & murmur)
§ Murmur (comment on 6 items)………… Timing (hand on pulse),
character, site, radiation, grade & changeable
At the end
§ Growth charts
§ Femoral pulses “No or ↓ : Infant or
Radiofemoral delay: elder child”
§ BP (4 limbs if suspect coarctation)
§ Other systems (Abdomen mainly for liver
& leg edema … signs
of heart failure, Rheumatic or endocarditis)
§ O2 Saturation
§ Offer to
look at ECG & CXR
Thank you sir
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