Interactive Guide to Physical Examination

The Cardiovascular Exam

The astute clinician can learn a great deal from a thorough cardiovascular examination. Even with technology that allows physicians to evaluate coronary arteries, the myocardium, and heart valves non-invasively, the physical examination still remains one of the most efficient and cost-effective tools for evaluating cardiac abnormalities.


This module will provide the learner with a review of cardiac anatomy and physiology, then describe and demonstrate the specific skills needed to perform a thorough cardiac examination. After completing this module, the student should be able to describe:

  • Basic cardiovascular anatomy and its relevance to the physical examination.
  • Cardiovascular physiology as it relates to physical examination.
  • Characteristics of, and techniques used to evaluate, the pulse and blood pressure.
  • Techniques used for inspection, palpation, and auscultation of the precordium.
  • Techniques used to evaluate the carotid impulse and height of the jugular venous wave form.
  • Selected advanced examination techniques used to evaluate abnormal findings.

Module Navigation:

Ideally the student should progress through the module using the menu on the left. Additional cues to access the glossary and interactive portions of the module can be found within the text.

Equipment needed:

  • Stethoscope with snug but comfortable ear pieces, tubing approximately 12 inches long, a fairly rigid diaphragm and a soft rimmed bell.
  • Pen light.
  • Ruler.
  • Another straight edge.

General approach to the cardiac examination:

The cardiac examination should take place in a quiet environment with good lighting. Where this is not feasible (e.g. in the emergency department), the examination should be repeated as soon as possible under more ideal conditions. In addition, the patient should be appropriately gowned; the cardiac exam should never be conducted through clothing or undergarments.

A systematic approach should be adopted which traditionally involves inspection, followed by palpation and then auscultation. In general, much of the examination should be conducted with the patient in the supine position or with the head of bed raised 15 - 30 degrees. The physician should utilize the left lateral decubitus position, the upright position, as well as have the patient stand and squat as necessary.