Cardiovascular Exam

System/Body Area

Elements of Examination

Constitutional

• Measurement of any three of the following seven vital signs: 1) sitting or standing blood pressure, 2) supine blood pressure, 3) pulse rate and regularity, 4) respiration,

5) temperature, 6) height, 7) weight (May be measured and recorded by ancillary staff)

• General appearance of patient (eg, development, nutrition, body habitus, deformities, attention to grooming)

Head and Face

Eyes

• Inspection of conjunctivae and lids (eg, xanthelasma)

Ears, Nose, Mouth and Throat

• Inspection of teeth, gums and palate

• Inspection of oral mucosa with notation of presence of pallor or cyanosis

Neck

• Examination of jugular veins (eg, distension; a, v or cannon a waves)

• Examination of thyroid (eg, enlargement, tenderness, mass)

Respiratory

• Assessment of respiratory effort (eg, intercostal retractions, use of accessory muscles, diaphragmatic movement)

• Auscultation of lungs (eg, breath sounds, adventitious sounds, rubs)

Cardiovascular

• Palpation of heart (eg, location, size and forcefulness of the point of maximal impact; thrills; lifts; palpable S3 or S4)

• Auscultation of heart including sounds, abnormal sounds and murmurs

• Measurement of blood pressure in two or more extremities when indicated (eg, aortic dissection, coarctation)

Examination of:

• Carotid arteries (eg, waveform, pulse amplitude, bruits, apical-carotid delay)

• Abdominal aorta (eg, size, bruits)

• Femoral arteries (eg, pulse amplitude, bruits)

• Pedal pulses (eg, pulse amplitude)

• Extremities for peripheral edema and/or varicosities

Chest (Breasts)

Gastrointestinal

(Abdomen)

• Examination of abdomen with notation of presence of masses or tenderness

• Examination of liver and spleen

• Obtain stool sample for occult blood from patients who are being considered for thrombolytic or anticoagulant therapy

Genitourinary

(Abdomen)

Lymphatic

Musculoskeletal

• Examination of the back with notation of kyphosis or scoliosis

• Examination of gait with notation of ability to undergo exercise testing and/or participation in exercise programs

• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation of any atrophy and abnormal movements

Extremities

• Inspection and palpation of digits and nails (eg, clubbing, cyanosis, inflammation, petechiae, ischemia, infections, Osler’s nodes)

Skin

• Inspection and/or palpation of skin and subcutaneous tissue (eg, stasis dermatitis, ulcers, scars, xanthomas)

Neurological/

Psychiatric

Brief assessment of mental status including

• Orientation to time, place and person,

• Mood and affect (eg, depression, anxiety, agitation)