Benchmarks for the CV Exam
You should be able to demonstrate each of the following on a patient or on an Objective Structured Clinical Encounter (OSCE)
Inspection
- Inspect the anterior chest and neck for skin lesions as you perform the exam
- Inspect the precordium for abnormal movement
Palpation
- Palpate the carotid arteries, one at a time, observing strength & symmetry (may also be done with H&N exam)
- Palpate the apical impulse and interpret your findings
Auscultation
- Listen at each of the primary listening areas with firm pressure on the diaphragm:
- Right 2nd intercostal space (R upper sternal border)
- Left 2nd intercostal space (L upper sternal border)
- Left lower sternal border (along the sternum at the 5th intercostal space)
- Cardiac apex (midclavicular line in the 4th – 5th intercostal space)
- Listen light pressure on the diaphragm or with the bell at the cardiac apex
- Listen for bruits over each carotid artery
Peripheral Circulation & Edema
Note the presence and severity of leg edema
Palpate each of the following pulses on each side:
- Radial
- Femoral
- Dorsalis pedis
- Posterior tibialis
Recognize common findings on the cardiovascular exam, including.
- Three systolic murmurs (aortic stenosis, mitral regurgitation, innocent murmur)
- Two diastolic murmurs (aortic regurgitation, mitral stenosis)
- Physiologic and abnormal splitting of S2
- S3 and S4
Perform hypothesis driven exam maneuvers:
- If you suspect abnormal volume status, measure jugular venous pressure
- If you suspect ventricular hypertrophy or valvular heart disease, assess the apical impulse