Cardiac examination

In medicine, the cardiac examination, also precordial exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation. The patient is positioned in the supine position tilted up at 45 degrees if the patient can tolerate this. The head should rest on a pillow and the arms by their sides. The level of the jugular venous pressure (JVP) should only be commented on in this position as flatter or steeper angles lead to artificially elevated or reduced level respectively. Also, left ventricular failure leads to pulmonary edema which increases and may impede breathing if the patient is laid flat. Lighting should be adjusted so that it is not obscured by the examiner who will approach from the right hand side of the patient as is medical custom. The torso and neck should be fully exposed and access should be available to the legs. General Inspection: Inspect the patient status whether he or she is comfortable at rest or obviously short of breath. Inspect the neck for increased jugular venous pressure (JVP) or abnormal waves. Any abnormal movements such as head bobbing. There are specific signs associated with cardiac illness and abnormality however, during inspection any noticed cutaneous sign should be noted. Inspect the hands for: Temperature – described as warm or cool, clammy or dry Skin turgor for hydration Janeway lesion Osler's node At the nails Splinter hemorrhage and Quincke's pulsation should be looked for as well as any deformity of the nail such as Beau's lines, clubbing or peripheral cyanosis. Inspect the head for: Cheeks for the malar flush of mitral stenosis. The eyes for corneal arcus and surrounding tissue for xanthalasma. Conjunctiva pallor a sign of anemia. The mouth for hygiene.