General Examination(CVS)

Cardiovascular System :

1. Pulse (all the following features should be seen in radial pulse):

• Rate (beat/min)
• Rhythm (interval between two beats)
• Volume—low, high or normal (make sure you lift the arm to see collapsing pulse)
• Character (normal, slow rising, collapsing)
•  Condition of the vessel wall (if normal, tell, “neither thicken nor tortuous”)
•  Radio-femoral delay and radio-radial delay (or inequality).

Compare all other pulses simultaneously (beware of the carotid pulse that should not be seen simultaneously). Volume and character of the pulse are better seen in the brachial and carotid artery.

Collapsing pulse in aortic regurgitation and pulsus alternans in acute left ventricular failure are better seen in the radial artery.

2. Neck veins (JVP): The patient should lie at 45°:

• Normal or engorged (internal jugular vein that lies medial to the sternomastoid). If visible, see any prominent wave. Always see hepatojugular reflux. Next, measure the height from the sternal angle (it indicates the mean pressure in the right atrium. Normally, it is at the level of the sternal angle and invisible).
• Other signs in neck:
•  Tall, sinuous venous pulse, oscillating up to the ear lobule (indicates prominent V wave, found in tricuspid regurgitation)
•  Dancing carotid pulse (called Corrigan’s sign found in aortic regurgitation)
•  Vigorous arterial pulsation in neck (found in coarctation of aorta)
•  Other pulsation in neck (carotid aneurysm or subclavian artery aneurysm).

3. Blood pressure (BP):

•  Measure BP (normal or high):
• Low systolic, normal diastolic and narrow pulse pressure (found in aortic stenosis)
• High systolic, low diastolic and wide pulse pressure (found in aortic regurgitation) (If needed, see in both arms, also in standing and lying to see postural hypotension). examination