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Cardiovascular History

1. Chest pain / discomfort (SOCRATES)

2. Dyspnea (exertional, orthopnea, paroxysmal nocturnal dyspnea)
3. Palpitations (onset, slow vs fast, regular vs irregular, missed beat sensation)
4. Fatigue (onset)
5. Syncope, dizziness (onset, conscious vs unconscious)
6. Intermittent claudication (distance walked before leg pain)
7. Ankle swelling (symmetrical vs asymmetrical, how far up leg)
8. Past medical /surgical history (MI, angina, rheumatic fever, HTN, congenital, infections,
dental work) (angiogram, CABG, transplant, valve replacement, angioplasty)
9. Family history (DM, HTN, Marfan’s, Mitral Valve prolapse, Congenital MI)
10. Social History (Smoking, alcohol, activity levels, cholesterol diet, house description)
11. Drug history, allergies
12. Systemic inquiry (Pulmonary, GI, Nervous system)

Cardiovascular Examination
1. Wash hands
2. Greet patient, always go to the right side of the patient
3. Introduction, ask for consent
4. Raise patient’s bed (patient lying supine and reclined at 45 degrees)
5. Ask if patient is comfortable
6. Expose necessary parts of patient
7. Handshake, detect any temperature changes (if slightly elevated temperature, check
forehead), any sweating, any peripheral cyanosis
8. Examination of hands (clubbing, cyanosis, Janeway lesion, Osler nodes, splinter
9. Check nail bed, press end of finger for 5 secs (capillary refill time, make sure <2s)
10. Check radial pulse (30 secs) (rate, characteristic of pulse, rhythm, volume)
11. Check for collapsing pulse (lift up patient’s arm)
12. Roll radial artery (check for atherosclerosis)
13. Palpate the brachial pulse (assess its character)
14. Check blood pressure (if blood pressure raised, compared both arms)
15. Check face (pallor / cyanosis)
16. Check eyes (xanthelasma, arcus), ask patient to look down to check for yellowing of
sclera in jaundice, inspect conjunctiva for signs of anemia
17. Check mouth, tongue (central cyanosis), tonsils (Rheumatic heart disease presents
18. Palpate areas for tenderness (aortic, pulmonic, tricuspid, mitral, Erb’s point)
19. Examine the neck (jugular venous pulse wave pattern, jugular venous pressure, any
sustained hepatojugular reflux, carotid bruits, thyroid) (turn the patients head)
20. Examine precordium (shape, symmetry, apical beat, pulsations, respiration)
21. Note any surgical scars / scars pigmentation on chest
22. Locate apex and note site (usually 5th intercostal space midclavicular line), size,
character of apical beat
23. Palpate areas for tenderness (aortic, pulmonic, tricuspid, mitral, Erb’s point)
24. Palpate for pulsations and thrills in other areas
25. Look for left parasternal heave, right ventricular heave
26. Percuss the right and left borders of the heart (optional)
27. Auscultate at least 4 areas (some in left lateral recumbent position, some in aortic)
Abdomen & Thorax
28. Check patient back for sacral edema
29. Check base of lung (crepitations)
30. Check abdomen (aortic pulsation, enlarged liver)
31. Check feet (scars, clubbing, varicose vein, temperature, intermittent claudication,
dorsalis pedis pulse, popliteal pulse)