Cardiovascular System

Name Occupation
Age Address
Sex Socioeconomic Status

Presenting Complaints:
Chest Pain / Breathlessness / Palpitations / Hemoptysis / Syncope / Swelling of Feet

H/o Presenting Illness:

Chest Pain: Duration / Onset / Site / Type / Nature of Pain / Progression
Aggravating / Relieving Factors
Associated With Sweating / Nausea / Vomiting / SOB
Episodes - Episodic/ Continuous
Lasting / Radiation

Breathlessness: Duration / Onset / Progression / Grading NYHA

Orthopnea / Platypnea / Trepopnea / PND
Aggravating / Relieving Factors

Palpitations: Duration / Onset / Progression / Grading NYHA

Regular / Irregular
At Rest / Exertion
Associated with SOB
Aggrevating / Relieving Factors

Hemoptysis: Duration / Onset / Progression / Episodes

Amount / Fresh Blood / Altered

Syncope: Duration / Onset / Progression / Episodes

Lasting / Aggravating / Relieving Factors
Relation with Exertion

Swelling of Feet [Dependent edema—sacral]: Duration / Onset / Site

Aggravating/Relieving Factors
Time of Day Variation

General History: Appetite / Rt. Hypochondric Pain / Loss of Weight

Fatigue / Sleep / Bowel Bladder Habits / Fever
Cyanotic Spells / Oliguria
Past History
CHF: H/O Anorexia / Right Hypochondrium Pain / Pedal Edema
Orthopnea / PND

RHD: Fever with Sore Throat / Fleeting Joint Pain

H/O Taking Penicillins

Infective Endocarditis: H/o Fever / Dental Procedures / GIT or Genitourinary Procedures

CHD: Failure of Cry after Birth / Failure to Thrive

Recurrent RTI / Squatting / Episodes
Cyanotic Spells / Consanguinity

H/o Diabetes / HTN / Asthma / PTB / Unprotected Sex

CAD / COPD / CVA / Malignancy

Personal History
Smoking / Alochol
Bowel and Bladder Habits
Diet - Veg / Mixed
Sleep Habits
Loss of Weight / Appetite

Family History
H/o CHD / IHD / HTN / DM / SCD

Treatment History
Any Rx Received so far
H/O Drug Allergy / Reactions
Any Surgical Intervention / Chemotherapy

Menstrual / Obstetric History

Menarche / Duration / Quantity
Any Dysmenorrhoea / Amenorrhoea
No of Pregnancies / Complications / Mode of Delivery
H/O Recent Delivery
 General Examination
Built / Nourishment
Pallor / Icterus
Cyanosis – Central / Peripheral
Clubbing – Bilateral / Unilateral / Pandigital / Limited
Pedal Edema:Bilateral / Unilateral / Painless / Painful /
Pitting (Soft/Hard) / Non-pitting / Extension/ Regional
Lymphadenopathy / Significant Lymphadenopathy

Markers of Congenital Heart Disease:

Dwarfism / Gigantism
Head / Neck -Low Set Ears / Hyperteleroism / Mongoloid Facies /
High Arched Palate / Webbed Neck
Trunk - Kyphoscoliosis / Chest Wall Deformities
Upper Limbs - Absent Radius / Syndactyly / Polydactyly / Arachnodactyly / Simian Crease
Lower Limbs - Rocker Bottom Feet / Sandal Gap

Rheumatic Fever: Arthritis / Erythema Marginatum /

Subcutaneous Nodules / Sydenhams Chorea

Infective Endocarditis: Pyrexia

Anemia / Fever / Jaundice / Roth Spots Pallor
Splinter Hemorrhages / Clubbing Petechiae
Oslers Nodes: Painful pink pea-sized on pulp of fingers Pulselessness
Janeway Lesions: Painless rash over palms & soles Phalangeal clubbing
Petechiae / Splenomegaly Palpable spleen
Neurological (Stroke, seizure, meningitis), Hematuria (MPGN)

Atherosclerosis: Arcus Senilis / Xanthelasma / Nicotine Staining / Xanthomas

Marfanoid Habitus: Arm Span:Height Ratio / Upper Segment:Lower Segment Ratio

Wrist Sign / Thumb Sign

Vital Signs:
Pulse: Rate / Rhythm / Volume / Character / Radioradial / Radiofemoral Delay
Condition of Vessel Wall / Felt in All Peripheral Pulses / Apex Pulse Deficit
Blood Pressure: supine / standing in all 4 limbs, Hills Sign
Respiratory Rate / Regular or Not / Type - Abdominothoracic or Thoracoabdominal
Temperature
 CVS Examination
Examination of Neck
JVP – Raised or not / Pressure / Waveforms / Hepatojugular reflux
Carotids,
Trachea - Midline/ Shifted,
Thyroid

Inspection of Chest
Chest wall Shape & Symmetry / Chest Wall Deformities
Precordial Bulge
Apical Impulse - Site / Diffuse / Localized
Other Pulsations- Parasternal / Pulmonary / Aortic / Suprasternal / Supraclavicuar
Epigastric / Interscapular
Dilated Veins / Scars / Sinuses

Palpation
Apical Impulse – Site / Normal / Tapping / Heaving / Hyperdynamic / Specific Character
Palpable Sounds, Palpable P2
Parasternal Heave Grading
Pulmonary Arterial Pulsations, Palpable Aortic / Suprasternal /Epigastric Pulsations
Thrill - Precordial / Carotid Thrill
Palpable pericardial rub
Dilated Veins - Direction of Flow

Percussion
Upper Border of Liver Dullness
Right Border - Corresponds to Right Sternal Border
Left Border - Corresponds To Apex Beat
No Dullness beyond Apex Beat
Left 2nd ICS Dullness - Normal

Auscultation
Mitral Area: S1 - Normal/ Low / Loud
S2 – Heard / S3 / S4
Opening Snap / Mitral Clicks
MDM - A Low Pitched, Rough Rumbling Mid Diastolic Murmur of Grade---is heard
with the Bell of stethoscope with Presystolic Accentuation with the patient in the
Left Lateral Position in Expiration. Non-Radiating (MS)
PSM or HSM - A High Pitched, Soft Blowing Systolic Murmur of Grade ---- is heard
with the Diaphragm of stethoscope conducted to the Axilla / Base with the
patient in the Left Lateral Position in Expiration (MR)
Tricuspid Area: S1 / S2 / S3 / S4
MDM: A Low Pitched, Rough Rumbling Mid Diastolic Murmur is heard with the
Bell of stethoscope with Presystolic Accentuation with the patient in the Supine
Position in Inspiration (TS)
PSM or HSM: A High Pitched, Soft Blowing Holo Systolic Murmur of Grade---- is
heard with the Diaphragm of stethoscope with the patient in the Supine Position
in Inspiration. (TR)

Pulmonary Area: S1 / S2
S2 Split
P2 Loud / Single 2nd Heart Sound
Pulmonary Ejection Click
ESM: A High Pitched, Crescendo Decrescendo Ejection Systolic Murmur of Grade--
-- is heard with the Diaphragm of stethoscope with the patient in the Supine
Position with the breath held in Inspiration. (PS)
EDM: A High Pitched, Soft Blowing Early Diastolic Murmur is heard with the
Diaphragm of the stethoscope with the patient in the Sitting Position Leaning
Forward With Inspiration. (PR)

Aortic Area: S1 / S2
Ejection Click
ESM: A High Pitched, Rough Crescendo Decrescendo Ejection Systolic Murmur of
Grade---- is heard with the Diaphragm of stethoscope conducted to the Carotids
with the patient in the Sitting Position in Expiration. (AS)
EDM: A High Pitched, Soft Blowing Early Diastolic Murmur is heard with the
Diaphragm of the stethoscope with the patient in the Sitting Position Leaning
Forward in Expiration (AR, aortic root dilatation)

Second Aortic Area (Erbs Area): S1 / S2

EDM: A High Pitched, Soft Blowing Early Diastolic Murmur is heard with the
Diaphragm of the stethoscope with the patient in the Sitting Position Leaning
Forward in Expiration (AR, primary valvular disease)

Infraclavicular Area (Gibsons Area):

Continuous Murmur: A High Pitched, Continuous Machinery Murmur with a
Crescendo Decrescendo Quality that begins in Systole, Peaks around S2 and
continues in to all or part of diastole conducted to the Back, is heard with the
Diaphragm of the stethoscope in the Left 1st ICS in Supine Position. (PDA)
Other Systems
Respiratory: Tracheal Position / Movement of Chest Wall /
Breath Sounds / Added Sounds
Abdomen: Soft Liver / Hepatojugular Reflex / Ascites / Spleen
CNS: FND

Diagnosis
o Acquired Valvular Heart Disease / Rheumatic Etiology
With Pulmonary Hypertension / AF
Evidence of Congestive Heart Failure
With or Without Signs of Active Rheumatic Fever / Infective Endocarditis

o Congenital Cyanotic or Acynatoic Heart Disease

With Left to Right Shunt or Right to Left Shunt
With Pulmonary Hypertension
With Evidence of Congestive Heart Failure
With or Without Signs of Infective Endocarditis / AF