Introduction: Introduce yourself to the patient

For eg. "Hello, my name is Dr..... and I am one of the physicians working at this clinic. Today, I will be examining your heart. During my examination, I will be looking, feeling and listening to your heart. At any time, if you feel uncomfortable, please let me know and we can stop. How does that sound?"

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1) Vitals: ask for vitals before you proceed.

2) General inspection:

• Comment if the patient appears well and is in no apparent distress.

• Eyes: Look for Pallor & Jaundice, corneal arcus or xanthelasma. (its nice to mention about doing a fundoscopic exam: looking for any retinal changes related to Hypertension)

• Neck: Measure the JVP (+/- hepatojudular reflex & Kaussmaul test: while patient holding their breath) + Listen to the carotids for bruits

• Mouth: Look for Central cyanosis & dental hygiene

• Hands: Capillary refill (<2 secs) & temperature, Check for clubbing, Osler nodes, Janaway lesions and splinter hemorrhage + peripheral cyanosis, koilnychia or leukonychia and nicotine stain & xanthomas

• Pulse: Radial pulse for Rate and rhythm, collapsing pulse (by raising the patient's arm) & radio-radial delay +/- peripheral pulses

3) Inspection (chest):

• Scars, masses, rash, dilated veins or any visible deformity

• Signs of pectus excavatum or carinatum

• chest movement with respiration (symmetrical)

• Look for visible apical pulse (5th intercostal space, midclavicular line)

4) Palpation:

• Apical beat: Location (5th IC space, midclavicular line), Amplitude (light tap), Duration (< 2/3 systole) and Size (smaller than a quarter)

• Heaves (sign of LVH): best palpated over the left sternal border with palm or heel of hand

• Thrills (basically a palpable murmur): over the 4 heart valves

5) Auscultation:

• Listen to all heart valves with diaphragm & bell: and comment on heart sounds (normal S1, S2) + if there are no additional heart sounds, rubs and murmurs

• Listen to the back for pleural effusion.

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Note: if there’s any murmur ask the patient to exhale and hold and listen to the murmur using the bell (patient should lie on left side for mitral valve and sitting for aortic) + palpate radial pulse at the same time to distinguish between systolic or diastolic murmurs.

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6) End your exam by checking for sacral & pedal edema.

7) Thank the patient!