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CVSPhysical
Examination Hadeel Khadawardi, teaching assistant at Internal
Medicine Department, Faculty of Medicine, Umm Al-Qura University
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General Approach
Vital Signs
Position 45
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Peripheral Exam Pericardium Exam
Hand Wrist + Arm Face Neck
Inspection Palpation Auscultation
CVS Exam
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Hand
Nail Dorsum Palm
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Nail
Clubbing
Peripheral Cyanosis
Splinter Hemorrhage
What are the causes of clubbing?
Hand
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Dorsum
Muscle Wasting
Tendons xanthomata
Hand
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Palm
Osler’s Nodules
Janeway Nodules
Palmer Xanthomata
Hand
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Wrist + Arm Radial Pulse Rate Rhythm Volume Character Radio-radial delay Radio-femoral delay
Blood Pressure
What are the different characters of arterial
pulses ?
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Face
Eyes Cheeks Mouth
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Face
Eye
Jaundice
Pallor
Xanthelasma
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Face
Cheeks
Mitral Face
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Face
Mouth
Peripheral cyanosis Central cyanosis Jaundice Infected teeth High arch palate
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Neck
Carotid Pulse
JVP
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Pericardium
Inspection
Scar
Skeletal Deformity
Visible Apex Beat
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Palpation Apex Beat - Site - Size - Character Heave Thrill
What can you do if you couldn’t feel the apex beat?What are the possible causes of difficult apex beat palpation?
What are the different characters of apex beat?
Pericardium
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Auscultation Pericardium
Mitral area = Apex beat
Aortic area
Tricuspid area
Pulmonary area Axilla
Carotid
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Maneuver for aortic
regurgitation
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How to present your findings:
• S1 & S2
• Splitting of S2
• Added sounds
• Murmur
What are the causes of loud S1 & S2 ?
What are the causes of soft S1 & S2 ?
What are the causes of wide, fixed & reversed splitting of S2 ?
What are the causes of S3 & S4 ?
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How to present a sound of murmur:
Timing
Sub timing
Radiation
Grade
Area of greatest intensity
What are the timing and sub timing of cardiac
murmurs ?
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Dynamic Maneuver
All murmur increase with increases of venous return
Except in HOCM & MVP
Squatting to standing Standing to squatting Valsalva maneuver Respiration: Inspiration Expiration Isometric exercise (hand
grip)
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Back
Palpate for sacral edema
Auscultate lung bases
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Abdomen Enlarged liver
Ascites
Splenomegaly
Aortic aneurysm
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Lower Limbs Pulses: - Femoral - Popliteal - Posterior tibial - Dorsalis pedis
Pitting edema Achilles tendon xanthomata Signs of PVD Signs of DVT
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Always Love by your heart not by your mind ...