Guide to Clinical Examination/Cardiovascular examination

The cardiovascular exam consists of four portions: 1. Inspection 2. Palpation 3. Percussion 4. Auscultation

1.Inspection: A thorough inspection includes examination of the precordium. The patient should be at about a 30 degree angle to the ground. The examiner should look at the neck and note the pulsations of the jugular vein, which can be told apart from carotid pulsations by applying pressure distally and noting a cessation of pulsation. The examiner should also measure the height of the jugular venous pulse from the sternum. An abnormally high JVP may indicative of right heart failure. 2.Palpation: Palpation is done in different areas of the precordium ( Mitral area, Tricuspid area, pulmonary area, Aortic area ), the carotid pulsations and epigastric area. 3.Percussion: Percussion is done to define the borders of heart. This is not an important part of the cardiovascular examination. 4.Auscultation: Ausculation is important part of CVS examination. It includes auscultation of heart sounds and murmurs in all the four areas of precordium.