The cardiovascular examination (CVS) is the examination of patient's heart and circulatory system. The CVS exam does not simply focus on the chest but is also a systemic clinical examination of the patient. It is one of the core aspects of any OSCE exam. In the real world any patient that is admitted into the hospital needs to have a cardiovascular exam completed. Often patients with chest pain, shortness of breath or palpitations will need specific focus on their cardiovascular system due to the nature of their presenting complaint.
Wash your hands using the Ayliffe technique
Introduce yourself and give your name and grade
“Hi, my name is John Smith and I am a 4th year medical student”
Clarify patients identity by confirming name and asking for their DOB
Explain what examination you are performing and what it involves
“I have been asked to perform a Cardiovascular examination on you today. This involves having a look at your hands and face, having a feel of your chest and a listen to your heart”
“Would this be ok with you?”
Ask if they would like a chaperone
“The exam involves you having to remove your upper garment. Would you like a chaperone for the exam?”
Initially lie the patient at 45 degrees and expose them from waist up
Inspect the patient from the end of the bed and look for the following:
Inspect the hands and check for stigmata of cardiovascular disease.
Check the patient's pulse and resp rate. Time for 15 seconds and multiply by 4.
Next, inspect their eyes, mouth for the following.
There are seven features of a JVP than distinguish it from other vessels.
Raised (sign of fluid overload)
Kusmauls sign ‐ JVP rises on inspiration (cardiac tamponade, constrictive pericarditis)
Canon waves ‐ large a wave (complete heart block)
Inspect the chest again more closely and look for the following:
Palpate the chest wall, feeling for the following.
NB ‐ warn patient that you will be feeling under the left breast to feel for the apex beat
Heave ‐ hypertrophy
Thrill ‐ palpable murmur
Apex beat ‐ Normally 5th IC space mid‐clavicular line
listen to the following four areas of the chest for the heart sounds.
Mitral region (apex beat / 5th IC space)
Tricuspid region (4th IC space left sternal edge)
Pulmonary region (2nd IC space left sternal edge)
Aortic region (2nd IC space right sternal edge)
Inspect the back and check for the following.
Check for peripheral oedema. Note if it is pitting and to what level it extends.
Let the patient know you have finished examining them and thank them for their time. Be courteous and offer them help to get redressed.
“That’s the end of the exam. Thank you for your time. Would you like any help getting dressed?”
Turn to the examiner and state what else you would do to complete the exam.
“To complete the examination I would check the patients BP. I would also also perform fundoscopy of the eyes.”
Explain to the examiner what tests and investigations you would perform