Cardiovascular Physical Exam

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Vital Signs

heart rate, resp rate, blood pressure




Inspection and Palpation

Overall appearance - breathlessness, distress, etc. Body size (obesity, cachexia). Skin temperature, colour, and dryness. Urine output.



Hands and Arms


Cyanosis and capillary refill.

Splinter hemorrhages, Osler's nodes, and Janeway lesions (infective endocarditis).

Radial pulse for rhythm and brachial pulse for volume and contour.

Blood pressure.


Head and Neck

Jugular venous pressure for right heart pressure and volume status.

Carotid pulses for volume, character, and bruits.

Mouth for pallor, cyanosis, and dentition (IE)

Fundi for retinopathy

Face for signs of hyperlipidemia (xanthomas)



Chest wall, including pectus excivatum, pectus carinatum, or kyphoscoliosis.

Visible pulsations, helpful in directing towards point of maximal impulse (PMI).

Feel for the PMI. Lateral displacement suggests enlarged left ventricle, while downward displacement can occur with COPD. Volume overload causes a brisk apical impulse. Double or triple impulses may be felt, suggesting structural dysfunction.

Feel for thrills, lifts, heaves, and tapping.

Back for sacral edema.





Aortic aneurysm





Femoral pulses and radio-femoral delay.

Peripheral pulses

ankle edema

more stigmata of infective endocarditis.




using the stethescope

heart sounds



Resources and References

basic cardiovascular exam video (St George's University Clinical Skills Online)

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