1. CVS Physical Examination
Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University

2. General Approach
Vital Signs
Position 45

3. CVS Exam Peripheral Exam Pericardium Exam Hand Inspection Wrist + Arm
Face
Neck
Inspection
Palpation
Auscultation

4. Hand
Nail Dorsum Palm

5. Hand Nail Clubbing Peripheral Cyanosis Splinter Hemorrhage
What are the causes of clubbing?

6. Hand
Dorsum
Muscle Wasting
Tendons xanthomata

7. Hand
Palm
Osler’s Nodules
Janeway Nodules
Palmer Xanthomata

8. What are the different characters of arterial pulses ?
Wrist + Arm
Radial Pulse
Rate
Rhythm
Volume
Character
Radio-radial delay
Radio-femoral delay
Blood Pressure
What are the different characters of arterial pulses ?

9. Face
Eyes Cheeks Mouth

10. Face
Eye
Jaundice
Pallor
Xanthelasma

11. Face
Cheeks
Mitral Face

12. Face Mouth Peripheral cyanosis Central cyanosis Jaundice
Infected teeth
High arch palate

13. Neck
Carotid Pulse
JVP

14. Pericardium
Inspection
Scar
Skeletal Deformity
Visible Apex Beat

15. Pericardium 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?

16. Pericardium Auscultation Carotid Aortic area Pulmonary area Axilla
Tricuspid area
Mitral area = Apex beat

17. Maneuver for aortic regurgitation

18. 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 ?

19. What are the timing and sub timing of cardiac murmurs ?
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 ?

20. 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)

21. Back
Palpate for sacral edema
Auscultate lung bases

22. Abdomen
Enlarged liver
Ascites
Splenomegaly
Aortic aneurysm

23. Lower Limbs Pulses: Pitting edema Achilles tendon xanthomata
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis
Pitting edema
Achilles tendon xanthomata
Signs of PVD
Signs of DVT

24. Always Love by your heart not by your mind ...