SCHEME AND PROFORMA FOR CARDIOVASCULAR SYSTEM EXAMINATION

All vitals + PICyClO
[in head to toe examination: examine hands, nails and skin for splinter hemorrhage, vasculitic rash or petechiae, osler nodes, janeway lesions, cold extremities, erythema marginatum
Also examine face and eyes for corneal arcus, malar flush, xanthalesma, conjunctival petechiae, roth spots in fundoscopy]
JVP measurement with hepatojugular reflex


Precordial examination
Inspection: (patient supine with head 30-45 degree with chest exposed)
Shape: any deformity or Bulging
Pulsations: apical impulse/ mitral area
                        Aortic, pulmonary and tricuspid area
                        Suprasternal and parasternal area
                        (+epigastric pulsations)
Venous prominences
Scar marks
Inspection of back for kyphosis, scoliosis, suzman’s sign
Intercostal fullness

Palpation: (thrill and its radiating areas, palpable P2)
Mitral area: Apex beat (site and character)
                        Palpable heart sounds
                        Thrills
Tricuspid area: left parasternal heave
                        Palpable heart sounds
                        Thrill
Pulmonary area and aortic area: pulsations
                                                Palpable heart sounds
                                                Thrill
Thrill over carotid
Direction of blood flow if superficial veins are engorged

Percussion: not done routinely

Auscultation: USE BOTH BELL AND DIAPHRAGM for (normal, added sounds, murmurs-type, location, grade and radiation)
Heart rate
Rhythm
Heart sounds (all 4 areas)
Murmurs (all 4 areas)
Adventitious sounds (opening snap, ejection click, mid diastolic click, splitting of S2, pericardial knock)
Pericardial rub
Auscultation over carotid for bruits
{if murmur is present describe @ STRICC:
S: site (where best heard)
T:timing (systolic or diastolic)
R: radiation(occurs in direction of blood flow)
I:intensity (grading)
C:character (harsh, blowing, musical, rumbling,etc)
C: change with respiration or posture, best heard by diapgragm or bell}

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