Examination Of The Cardiovascular System - Keys To Performing a Respectful & Effective Exam - Observation, Palpation, Percussion & Auscultation

Sep 20, 2026

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A practical guide to cardiovascular system examination, covering appropriate history and review of systems, vital signs (blood pressure and pulse), assessment of distal vasculature for systemic vascular disease, and core physical exam components. It emphasizes pulmonary exam as forthcoming and outlines four basic approaches: observation, palpation, percussion (omitted in cardiac exam), and auscultation. Guidance includes respectful gown management and patient-touch technique to preserve modesty while enabling accurate heart and lung assessment, including surface anatomy and palpation methods such as identifying the PMI and key valve locations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages40

Reading Time1 h 41 min

AccessFree to download

Examination Of The Cardiovascular System

Vital Signs and Distal Vascular Assessment

Core Physical Exam Components

Gown Management and Respectful Patient Touch

Keys To Performing a Respectful & Effective Exam

Observation and Surface Anatomy

Valves and Areas of Auscultation

Palpation Technique (PMI, Left and Right Ventricles)

Examination Of The Cardiovascular System POM-October 9, 2019 Charlie Goldberg, M.D. [cggoldberg@health.ucsd.edu](cggoldberg@health.ucsd.edu) Cardiovascular Exam • Includes • appropriate history and ROS • Vital Signs: Blood pressure; Pulse: rate, rhythm, volume • Assessment distal vasculature (legs, feet, carotids) → vascular disease (atherosclerosis) is a systemic illness ! • Pulmonary Exam (coming soon) • 4 basic PE components: • Observation, Palpation, Percussion (omitted in cardiac exam)& Auscultation Thoughts On Gown Management & Appropriately/Respectfully Touching Your Patients • Several Sources of Tension: • Area examined reasonably exposed – yet patient modesty preserved • Palpate sensitive areas to perform accurate exam-requires touching people w/whom you’ve little acquaintance – awkward, particularly if opposite gender • Exam not natural/normal part of interpersonal interactions-as newcomers to medicine, you’re particularly aware & hence sensitive → a good thing! Keys To Performing a Respectful & Effective Exam • Explain what you’re doing (& why) before doing it→ acknowledge “elephant in the room”! • Expose minimum amount of skin necessary- “artful” use of gown & drapes (males & females) • Examining heart & lungs of female patients: • Ask patient to remove bra prior and/or learn to work around bra • Expose side of chest to extent needed • Enlist patient’s assistance→ positioning breasts to enable cardiac exam • Don’t rush, act in a callous fashion, or cause pain • PLEASE… don’t examine body parts thru gown: • Poor technique • You’ll miss things • You’ll lose points on scored exams (OSCE, CPX, USMLE)! Observation • Pay attention to: • Chest shape • Shortness of breath (@ rest or walking)? • Sitting upright? Able to speak? • ? Visible impulse on chest wall from vigorously contracting ventricle (rare) Surface Anatomy Finding The Sternal Manubrium Junction (aka Angle of Louis)– Key To Identifying Valve Areas Clavicle Clavicle Manubrium Sternum ~~ ~~ Sternal Manubrium Junction (Angle of Louis) 1st Rib 2nd Rib 2nd ICS Manubrium Sternal Manubrium Junction Sternum Manubrium slopes in one direction while Sternum angles in different direction. Highlighted by q-tips → intersection defines Sternal Manubrium Junction Valves And Surface Anatomy • Areas of auscultation correlate w/rough location of each valve • Where you listen will determine what you hear! More Anatomy @: [http://www.blaufuss.org/tutorial/indexTut.html](http://www.blaufuss.org/tutorial/indexTut.html) PIE Group: [http://pie.med.utoronto.ca/PIE/PIE_whatWeDo_valves.html](http://pie.med.utoronto.ca/PIE/PIE_whatWeDo_valves.html) Palpation-Technique Left ventricle - Fingers across chest, under breast (explain 1st) • Point of Maximal Impulse (PMI) → apex ventricle that pin-points w/finger tip; ~70% of patients-if not palpable, repeat w/patient on L side - Size of LV – increased dimension if PMI shifted to L of mid-clavicular line • Vigor of contraction • Palpable thrill (rare) -associated w/regurgitant or stenotic murmurs (feels like sensation when kink garden hose) For Male Patients For Female Patients Palpation – Technique (cont) • Right ventricle: • Vigor of contractility → heel of R hand along sternum • Rarely abnormal with RV (pulmonary hypertension)

FAQs

What vital signs and history elements are included in the cardiovascular exam?

The exam includes an appropriate history and review of systems, plus vital signs: blood pressure and pulse (rate, rhythm, and volume).

Which physical exam components are used for cardiac evaluation?

Four basic components are listed: observation, palpation, percussion (omitted in the cardiac exam), and auscultation.

How should clinicians perform a respectful and effective exam while using gowns and touching patients?

Explain what you’re doing and why before starting, expose only the minimum necessary skin using artful gown and drapes, ask for patient assistance with positioning when needed, don’t rush or cause pain, and avoid examining through the gown because poor technique leads to missed findings.

Sep 20, 2026

Upload by Kurz