Rhythm

TypeTemperatureJVP
Peripheral signs of AR - signs of wide pulse pressure:

Lighthouse sign - Alternate flushing and blanching of forehead

Landolfi’s sign
- pupil size varies with each heart beat

Becker’s
sign - Retinal artery pulsations

Muller’s sign
- Systolic pulsations of uvula

De Musset’s sign
- Head bobbing with each heartbeat

Corrigan’s sign
- Dancing carotids

Quincke’s sign
- Capillary pulsation of nail bed
Collapsing pulse

Pulsus bisferans - severe AR

Rosenbach’s sign
- Pulsation of liver

Gerhardt’s sign
- Pulsation of spleen

Traube’s sign
- Pistol shot femoral

Hill’s sign
- Popliteal systolic BP > Brachial BP >20 mm
o

Mile - 20 - 40
o

Moderate - 40 - 60
o

Severe - >60

Duroziez’s murmur
- Double murmur in femoral artery
Local Examination of CVS:Inspection:

Chest wall symmetry and shape

Kyphoscoliosis

Apical impulse

Tracheal position

Pulsations
o

Epigastric, hypochondrial
o

Parasternal
o

Supra & infraclavicular

o

Suprasternal, neck
o

Interscapular, suprascapular

Precordial bulge

Dilated veins

Signs of surgeries, scars

Drooping of shoulders

Oral cavity
Palpation:

Apical impulse - site/type/ associated thrill or sound

Epigastric pulsations

Parasternal heave

Thrills over precordium / carotids

Palpable sounds (P2)

Tracheal position
Percussion:

Right border corresponds to right border of sternum

Left border corresponds to apical impulse

Liver dullness is felt in …………….

Auscultation

Mitral
o

First and second heart sounds are heard

o

S1 / S2 - loud/normal/soft
o

Any S3 or S4
o

MDM: A rough rumbling low pitched MDM(of grade) heard with the bell of
thestethoscope with opening snap and PSA (pre systolic attenuation) and the
patientput left lateral position with breath held in expiratory apnea
o

PSM: A high pitched, soft blowing PSM (of grade) heard with the diaphragm of
thestethoscope, conducted to the axilla and back, the patient put in left lateral
withbreath held in expiratory apnea

Aortic:
o

First and second heart sounds are heard

o

S1/S2 - loud/normal /soft

o

Any ejection click

o

ESM: A crescendo decrescendo ESM(of grade) heard with the diaphragm of

thestethoscope and conducted to the carotids, the patient leaning forward
and breathheld in expiratory apnea
o

EDM: A decrescendo pitched EDM( of grade) is heard with diaphragm of

thestethoscope (better heard in the II aortic area say as LT with ICS parasternal)
withthe patient leaning forward with breath held in expiratory apnea

Pulmonary:
o
First and second heart sounds are heard
o

S1/S2 - loud/normal/soft
o

S2? Split? Narrow/ normal/ wide fixed / reverse

o

Any ejection click

o

For murmurs

See the aortic area

Say as in inspiratory apnea

No conduction as in ESM of AS

Patient in lying posture

Tricuspid:
o

First and second heart sound heard

o

S1/S2 - loud/ normal / soft

o

Any S3/ S4
Refer mitral area

Say as in inspiratory apnea

MDM: Patient leaning forward

PSM: Patient leaning forward, conduction to right sternumOther systems:

Respiratory system:
o

NVBS
o

Basal crepitations

Abdomen:
o

Any added sounds

o

No organomegaly
o

No free fluid

CNS:
o

No focal neurological deficit

Diagnosis:
Acquired/congenital heart disease of ………………….(rheumatic) etiology with
MS/MR/AS/AR.The patient is ……………………(not)in sound rhythm,………………../ not in
failure…………….. with /without
infective endocarditis complications.