[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › Cardiovascular system # Cardiovascular system Precordium, heart sounds and murmurs, jugular venous pulse, peripheral pulses and cardiovascular syndromes. 22 pages ## Sign - [**Abnormal pulses: paradoxus, alternans, parvus et tardus, bounding** The shape of the pulse, not just its rate, gives away heart problems: a pulse that weakens on…](https://durgical.com/en/clinical-exam/abnormal-pulses-paradoxus-alternans-parvus-et-tardus-bounding/) - [**Heart sounds: S1, S2 and its splitting, S3 and S4** The heart's two normal beats are its valves closing; extra sounds point to stiff or overloaded…](https://durgical.com/en/clinical-exam/heart-sounds-s1-s2-and-its-splitting-s3-and-s4/) - [**Murmurs: timing, grade, location and radiation** A murmur is the sound of turbulent blood flow; describing it well almost always tells which…](https://durgical.com/en/clinical-exam/murmurs-timing-grade-location-and-radiation/) - [**Signs of deep vein thrombosis: Homans and the Wells score** A swollen, warm, painful leg on one side may be a clot; a simple score helps decide whether to…](https://durgical.com/en/clinical-exam/signs-of-deep-vein-thrombosis-homans-and-the-wells-score/) ## Syndrome - [**Acute limb ischemia and chronic arterial insufficiency** A leg that suddenly turns cold, pale and pulseless is an emergency; pain on walking that stops…](https://durgical.com/en/clinical-exam/acute-limb-ischemia-and-chronic-arterial-insufficiency/) - [**Cardiac tamponade: Beck triad and pulsus paradoxus** Fluid or blood under pressure in the sac around the heart stops it from filling; it is an…](https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/) - [**Chest pain: ischemic, pericardial, pleural and other patterns** Not all chest pain comes from the heart, but the cardiac and life-threatening kinds must be…](https://durgical.com/en/clinical-exam/chest-pain-ischemic-pericardial-pleural-and-other-patterns/) - [**Heart failure syndrome: left- and right-sided signs** When the heart cannot pump well, fluid builds up behind it: in the lungs if the left side fails…](https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) - [**Hypertensive emergency: target-organ signs** Very high blood pressure is an emergency when it is already harming the brain, eyes, heart…](https://durgical.com/en/clinical-exam/hypertensive-emergency-target-organ-signs/) - [**Shock: the clinical signs and the types** Shock means the blood cannot deliver enough oxygen to the organs; it shows in the skin, the…](https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/) ## Maneuver - [**Allen test** Before puncturing the artery at the wrist, check that the hand's other artery can supply it on…](https://durgical.com/en/clinical-exam/allen-test/) - [**Dynamic auscultation: Valsalva, squatting, standing and handgrip** Changing the patient's posture or effort while listening alters murmurs and helps tell which one…](https://durgical.com/en/clinical-exam/dynamic-auscultation-valsalva-squatting-standing-and-handgrip/) - [**Hepatojugular (abdominojugular) reflux** Pressing the abdomen gently and steadily and watching whether the neck vein rises and stays up…](https://durgical.com/en/clinical-exam/hepatojugular-reflux/) - [**Varicose veins: the Trendelenburg (Brodie–Trendelenburg) test** Emptying the veins with the leg raised, applying a tourniquet and watching how they fill on…](https://durgical.com/en/clinical-exam/varicose-veins-the-trendelenburg-test/) ## Exam technique - [**Cardiac auscultation: the areas and the order** Listening to the heart at four set places on the chest, always in the same order, so no sound or…](https://durgical.com/en/clinical-exam/cardiac-auscultation-the-areas-and-the-order/) - [**Jugular venous pressure and the venous pulse** The height of the pulsation in the neck vein estimates the pressure inside the right heart, with…](https://durgical.com/en/clinical-exam/jugular-venous-pressure-and-the-venous-pulse/) - [**Peripheral pulses and the ankle–brachial index** Feeling the pulses in arms and legs and comparing ankle and arm blood pressure uncovers blocked…](https://durgical.com/en/clinical-exam/peripheral-pulses-and-the-ankle-brachial-index/) - [**Precordial inspection and palpation: apex beat, heaves and thrills** Looking at and feeling the chest over the heart tells a lot: where the apex beats, whether a…](https://durgical.com/en/clinical-exam/precordial-inspection-and-palpation-apex-beat-heaves-and-thrills/) ## Topic - [**Cardiac studies: stress test, Holter, echo, nuclear, EP study and cath** The main heart tests after the ECG: what each one shows, when it is chosen, how the patient is…](https://durgical.com/en/clinical-exam/cardiac-studies-stress-test-holter-echo-nuclear-ep-study-and-cath/) - [**Palpitations: what the patient feels, what to ask and the danger signs** Feeling the heart race, pound or skip: the questions that separate harmless extra beats from a…](https://durgical.com/en/clinical-exam/palpitations-what-the-patient-feels-what-to-ask-and-the-danger-signs/) - [**The abnormal ECG: hypertrophy, conduction blocks and main arrhythmias** How to recognise the most common abnormal ECG patterns: a thick heart wall, blocked wiring, and…](https://durgical.com/en/clinical-exam/the-abnormal-ecg-hypertrophy-conduction-blocks-and-main-arrhythmias/) - [**Valve murmurs: the table to know** The seven most-tested murmurs side by side in one table: when they sound, where, where they…](https://durgical.com/en/clinical-exam/valve-murmurs-the-table-to-know/) ## A to Z - [A](https://durgical.com/en/clinical-exam/a-z/a/) - [B](https://durgical.com/en/clinical-exam/a-z/b/) - [C](https://durgical.com/en/clinical-exam/a-z/c/) - [D](https://durgical.com/en/clinical-exam/a-z/d/) - [E](https://durgical.com/en/clinical-exam/a-z/e/) - [F](https://durgical.com/en/clinical-exam/a-z/f/) - [G](https://durgical.com/en/clinical-exam/a-z/g/) - [H](https://durgical.com/en/clinical-exam/a-z/h/) - [I](https://durgical.com/en/clinical-exam/a-z/i/) - [J](https://durgical.com/en/clinical-exam/a-z/j/) - [K](https://durgical.com/en/clinical-exam/a-z/k/) - [L](https://durgical.com/en/clinical-exam/a-z/l/) - [M](https://durgical.com/en/clinical-exam/a-z/m/) - [N](https://durgical.com/en/clinical-exam/a-z/n/) - [O](https://durgical.com/en/clinical-exam/a-z/o/) - [P](https://durgical.com/en/clinical-exam/a-z/p/) - [R](https://durgical.com/en/clinical-exam/a-z/r/) - [S](https://durgical.com/en/clinical-exam/a-z/s/) - [T](https://durgical.com/en/clinical-exam/a-z/t/) - [U](https://durgical.com/en/clinical-exam/a-z/u/) - [V](https://durgical.com/en/clinical-exam/a-z/v/) - [W](https://durgical.com/en/clinical-exam/a-z/w/) [← Clinical examination](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/areas/cardiovascular/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/areas/cardiovascular/