Cardiovascular & Respiratory Clinical Examination
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Lesson 1 of 7
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Cardiovascular & Respiratory Clinical Examination
Cardiovascular Examination — Key Steps
Hands: clubbing (IE, cyanotic CHD, lung Ca), splinter haemorrhages (IE), peripheral cyanosis, koilonychia (IDA)
Face: malar flush (mitral stenosis), corneal arcus/xanthelasma (hyperlipidaemia)
JVP: normal 1–2 cm above sternal angle at 45┬░; raised in: RHF, tamponade, SVC obstruction, fluid overload
- JVP vs carotid: JVP non-pulsatile (2 pulsations), non-palpable, changes with position and hepatojugular reflux
Precordium: apex beat normally 5th ICS, MCL; displaced in: cardiomegaly, pleural effusion, pneumothorax
Heart sounds:
- S1 (mitral/tricuspid closure); S2 (aortic/pulmonary closure)
- S3: ventricular filling sound, normal in young; pathological in HF (gallop rhythm)
- S4: atrial contraction against stiff ventricle — LVH, hypertension
Murmur Classification
| Murmur | Timing | Radiation | Cause |
|--------|--------|-----------|-------|
| Aortic stenosis | Ejection systolic | To carotids | Calcification, bicuspid valve |
| Mitral regurgitation | Pan-systolic | To axilla | MVP, rheumatic, IE |
| Aortic regurgitation | Early diastolic | Left sternal edge | Marfan, IE, bicuspid |
| Mitral stenosis | Mid-diastolic | None | Rheumatic fever |
Respiratory Examination
Inspection: respiratory rate, accessory muscle use, chest deformity (barrel chest = COPD), scars
Percussion: dull = consolidation/effusion/collapse; hyper-resonant = pneumothorax/emphysema
Auscultation:
- Bronchial breathing: consolidation (sounds travel well through solid lung)
- Fine crackles: pulmonary oedema, fibrosis
- Coarse crackles: bronchiectasis, secretions
- Wheeze: asthma, COPD (expiratory)
- Pleural rub: pleuritis, PE