CARDIAC EXAMINATION

INSPECTION:

• Peripheral cyanosis
• koilonychia
• Finger clubbing
• Splinter haemorrhages
• Nicotine staining
• Edema__
• Note

PALPATION

• Pulses

o Radial pulse

 Rate
 Rhythm

• Regular
• Regularly irregular
• Irregularly irregular
• Collapsing pulse
• Equal pulse
• Unequal pulse

o Carotid pulse
 Volume
• Normal
• Increased
• Decreased
 Upstroke
• Normal
• Delayed
• Brisk
 Character
• Anacrotic pulse
• Fall away quickly
• Collapsing pulse
• Single beating
 • Twice beating

o Jugular venous pulse

• Normal
• Increased
• Decreased
• No change to prior visit
• Dominant a wave
• Cannon a wave
• Dominant v wave
• Absent x descent
• Exaggerated x descent
• Sharp y descent
• Slow y descent
• Regular
• Abdominojugular reflux
• Pulsatile liver
• Notes

o Femoral pulse
• Radial femoral delay present/absent
• Grade
o 0=absent
o 1=diminished
o 2=normal
o 3=increased
o 4=bounding
o Dorsalis Pedis pulse
o 0=absent
o 1=diminished
o 2=normal
o 3=increased
o 4=bounding
o The posterior Tibial pulse
o 0=absent
o 1=diminished
o 2=normal
o 3=increased
 o 4=bounding
o APEX BEAT
• Normal
• Absent
• Shifted to
o Right
o Left
• Shifted
o With trachea
o With out trachea
• Intensity
o Normal
o Double impulse
o Dyskinetic
o Hyperdynamic
o Hyperkinetic
o Tapping apex
• Palpable
• Notes

AUSCULTATION

• S1
o Soft
o Loud
• S2
o Soft
o Loud
 Aortic
 Pulmonary
• Splitting
o Increased
o Fixed
• S3
• S4
• Murmurs
o Intensity
 I/VI
 II/VI
 III/VI
 IV/VI
  V/VI
 VI/VI
o Duration ____
o Timing
 Systolic
 Diastolic
o Quality
 Ejection murmurs
 Constant intensity murmurs
 Musical
 Blowing
 Harsh
 Rumbling
o Pitch
 High
 Medium
 Low
o Location ____
 LUSB
 LLSB
 RSB
o Radiation_____
o Relationship to respiration inspiration/expiration
o Relationship to position____
o Other associated sounds___
o Notes
 Midsystolic murmur
 Pansystolic (or holosystolic) murmur
 Late systolic murmur
 Early diastolic murmur
 Middiastolic murmur
 Late diastolic (or presystolic) murmur
 Continuous murmur
 Crescendo murmur
 Decrescendo murmur
 Crescendo-decrescendo murmur

• Rhythm
o Regular
o Irregular
o Regularly irregular
o Irregularly irregular
• Friction Rub
o Present
o Absent