4 Cardiovascular System Examination

A. CAS ESHEET FORMAT

-- • Dyspepsia
• Local tenderness
HISTORY TAKING • Angina equivalents.
Dyspnea
Name: Diaphoresis .
Discomfort in lower Jaw
Age:
Dyspeptic symptoms
Sex:
Fatigue
Residence:
Occupation: paJpitati~ns: /
. . hronological order): • Duration
Chief complaints (describe m c
• Onset
I. _xdays • Fast or slow
2. _xdays • Regular or irregular
3. _xdays • Precipitating factors
• Associated symptoms
Dyspnea:
Stoke Adams
• Duration /
• Post-palpitati~iuresis
• Onset /
• Grade Syncope: /
• Progression • Duration
• Aggravating factors
• Onset
• Relieving factors
• No of attacks
• 0rthopnea
• Trepopnea • Awareness
• Platypnea • Precipitating factors
• Bendopnea
• Paroxysmal nocturnal dyspnea ;ed:::c~::: sympt/
• Associated symptoms
1 Wheeze
• Duration /
1 Cough with expectoration • Onset
• Progression
Chest pain: / • Aggravating factors
• Duration
• Relieving f a c t o r r
• Onset • Is it preceded by f ial puffiness or followed by facial
• Site
puffiness?
• Type of pain
• Radiation Other symptoms:
• Diuma1 . . • Hemoptysis
• A vanation (nocturnal angina)
• g~avating factors • Cyanosis
• ~heving factors • Decreased urine output
• sociated symptoms • Gastrointestinal symptoms
Nausea' vomiting,
· • sweating • Right hypochondria! pain

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I
An Insider's Guide to Clinical Medicine

• Cooperative
• Fatigability • Obeying commands
• Fever
• Rheumatic fever history Body Mass Index (BMI)
• Infective endocarditis • Weight (kg)/H2(meters)
• Cyanotic spells • Grading according to WHO for South t
• Squatting after exertion tries eaS Asian c011n
Past history: • Armspan
• Asthma • Upper segment: Lower segment ratio
• Chronic obstructive airway disease
• Tuberculosis Vitals Examination
• History of contact with tuberculosis • Pulse
• Diabetes mellitus Rate
• Hypertension Rhythm
• Ischernic heart disease (!HD) Volume
• Seizure disorder Character
• History of sudden cardiac death. Vessel wall thickening
Radioradial delay and radiofemoral delay
Family history:
Peripheral pulses
Three generation pedigree chart to be drawn
• Blood pressure
Personal history: Rightarm
• Bowel habits Leftarm
• Bladder habits Leg-right and left
• Appetite Postural drop in BP
• Loss of weight • Respiratory rate
• Occupational exposure Regular/irregular
• Sleep Abdominothoracic (male) or thoracoabdomirc
• Dietary habits and taboo (female)
• Food allergies Usage of accessory muscles
• Smoking Index or Pack years • Jugular venous pressure
• Alcohol history (if yes mention in grams of alcohol) Centimeter (cm) of water (blood) above sternal aif
(+ 5 cm from the right atria)
Treatment history:
• Jugular venous pulse
• Drugs using
• Frequency of drug (e.g., drug taken 5 times a week most Waveform
likely to be digoxin) • Pulse oximetry
• Duration of usage
• Any blood test to be monitored (e.g., INR for warfarin) Physical Examination
• Any intramuscular injections (once in 3 weeks IM • Pallor:
injection most likely to be benzathine penicillin for • Icterus:
rheumatic heart disease prophylaxis) • Cyanosis:
• Clubbing:
Menstrual and obstetric history:
• Lymphadenopathy:
• Gravida, parity, live births, abortions (GPLA)
• Edema:
• Age of m enarche
• Menopause at Others
• Duration
• Signs of infective endocarditis 1
5et
Summarize: • Signs of rheumatic fever . al heart di ·
Differential diagnosis: • Any dysmorphies/stigmata od congeillt
1.
2. SYSTEMIC EXAMINATION
3.
Inspection
GENERAL EXAMINATION • Chest shape and symmetry
• Breast abnormalities
Patient • Spine deformity
• Conscious • Scars
• Coherent • Precordial prominence

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 Cardiovascular System Exam ination

I , cardiovascular pulsations
• Erb's neoaortic area
SI
1 Apical pulse S2
pulsation in aortic and pulmonary area
1 S3,S4
Sternoclavicular pulsations OS/clicks
1
Left parasternal pulsations Murmur
1
Epigastric pulsations 1. Timing
1
Ectopic pulsations 2. Grade
1
, Distended veins 3. Quality
4. Pitch
palpation 5. Configuration
, Confirmation of sha~e and symmetry 6. Radiation
, palpation ofprecord1um . . 7. Best heard with diaphragm or bell
• Palpation of cardiovascular pulsaaon for sounds, thnlls 8. Patient position
9. With breath held in inspiration or expiration
and rubs
10. Dynamic auscultation.
, Tracheal tug
• (R) 2nd intercostal space (aortic area)
percussion Sl
, Right heart border S2
, Left heart border S3,S4
, 2nd IC space OS/clicks
, Sternal percussion Murmur
1. Timing
Auscultation 2. Grade
, Apex (mitral area) 3. Quality
I Sl 4. Pitch
• S2 5. Configuration
S3,S4 6. Radiation
OS/clicks 7 . Best heard with diaphragm or bell
Murmur 8. Patient p osition
1. Timing 9. With breath held in inspiration or expiration
2. Grade 10. Dynamic auscultation.
3. Quality • (L) 2nd intercostal space (pulmonary area)
4. Pitch
5. Configuration Sl
6. Radiation S2
7. Best heard with diaphragm or bell S3,S4
8. Patient position OS/clicks
9. With breath held in inspiration or expiration Murmur
10. Dynamic auscultation 1. Timing
• Trlcuspid area 2. Grade
I Sl 3. Quality
S2 4. Pitch
1 S3, S4 5. Configuration
1 OS/clicks 6. Radiation
1 Murmur 7. Best heard with diaphragm or bell
1. Timing 8. Patient position
2. Grade 9. With breath held in inspiration or expiration
3. Quality
10. Dynamic auscultation.
4. Pitch
5· Configuration • Other areas
6- Radiation AJdlla
7· Be~t heard with diaphragm or bell Epigastrium
8· Patient position Clavicle
~- With br~ath held in inspiration or expiration Carotid
1 · Dynamic auscultation • Back (interscapular area)
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OTHER SYSTEM EXAMINATION
An Insider's Guide to Clinical Medicine

•
•
Percussion:
Auscultation:
Respiratory:
Nervous system:
• Inspection:
• Higher mental functions:
• Palpation:
• Cranial nerves:
• Percussion:
• Auscultation: • Sensory system:
• Motor system:
Gastrointestinal system: • Reflexes:
• Inspection: • Cerebellar system:
• Palpation: • Meningeal signs: