SCHEME OF SYSTEMIC CARDIOVASCULAR EXAMINATION: AN OVERVIEW
I. Examination of: Pulse, blood pressure (BP), neck veins.
II. Inspection:
Shape of precordium
Position of apical impulse
Pulsation
– Over precordium (aortic, pulmonary, mitral, parasternal areas)
– Neck (carotid pulsation), epigastrium
– Suprasternal area, supraclavicular area, locomotor brachialis
Skin: Engorged superficial veins, scar mark (e.g., for previous cardiac
operation), sinus, polythelia (additional nipple)
Back (kyphoscoliosis, arterial or venous pulsations, skin condition).
III. Palpation:
Appreciation of arterial pulses and determination of direction of venous flow
(in superficial veins)
Thrill in carotid artery
Palpable pericardial rub
Mitral area: Apex beat (site and character), palpable heart sound (M1), thrill
Pulmonary area: Pulsation, palpable heart sound (P2), thrill
Aortic area: Pulsation, palpable heart sound (A2), thrill
Tricuspid area: Left parasternal heave, palpable heart sound (T1), thrill.
IV. Percussion: Not done routinely (done in relevant cases like pericardial effusion,
huge cardiomegaly, or aneurysm of the arch of aorta).
V. Auscultation:
Cardiac rate (i.e., heart rate) and rhythm
Mitral area: Heart sounds, murmur (in details), opening snap, ejection click,
pericardial knock
Pulmonary area: Similar to mitral area
Aortic area: Similar to mitral area
Tricuspid area: Similar to mitral area
Neoaortic area (or, aortic II area): Similar to mitral area
Auscultation for pericardial rub and over carotid arteries (i.e., for carotid bruit).
I. Examination of: Pulse, blood pressure (BP), neck veins.
II. Inspection:
Shape of precordium
Position of apical impulse
Pulsation
– Over precordium (aortic, pulmonary, mitral, parasternal areas)
– Neck (carotid pulsation), epigastrium
– Suprasternal area, supraclavicular area, locomotor brachialis
Skin: Engorged superficial veins, scar mark (e.g., for previous cardiac
operation), sinus, polythelia (additional nipple)
Back (kyphoscoliosis, arterial or venous pulsations, skin condition).
III. Palpation:
Appreciation of arterial pulses and determination of direction of venous flow
(in superficial veins)
Thrill in carotid artery
Palpable pericardial rub
Mitral area: Apex beat (site and character), palpable heart sound (M1), thrill
Pulmonary area: Pulsation, palpable heart sound (P2), thrill
Aortic area: Pulsation, palpable heart sound (A2), thrill
Tricuspid area: Left parasternal heave, palpable heart sound (T1), thrill.
IV. Percussion: Not done routinely (done in relevant cases like pericardial effusion,
huge cardiomegaly, or aneurysm of the arch of aorta).
V. Auscultation:
Cardiac rate (i.e., heart rate) and rhythm
Mitral area: Heart sounds, murmur (in details), opening snap, ejection click,
pericardial knock
Pulmonary area: Similar to mitral area
Aortic area: Similar to mitral area
Tricuspid area: Similar to mitral area
Neoaortic area (or, aortic II area): Similar to mitral area
Auscultation for pericardial rub and over carotid arteries (i.e., for carotid bruit).