Cardiovascular examination frequently appears in OSCEs. You’ll be expected to pick up the relevant clinical signs using your examination skills. This cardiovascular examination OSCE guide provides a clear step by step approach to examining the cardiovascular system, with an included video demonstration.
Visible pulsations – forceful apex beat may be visible – hypertension/ventricular hypertrophy
Inspect chest for scars and deformity
Inspect axilla for scars
Located at the 5th intercostal space / midclavicular line
Palpate the apex beat with your fingers (placed horizontally across the chest)
Lateral displacement suggests cardiomegaly
A parasternal heave is a precordial impulse that can be palpated
Parasternal heaves are present in patients with right ventricular hypertrophy
Place the heel of your hand parallel to the left sternal edge (fingers vertical) to palpate for heaves
If heaves are present you should feel the heel of your hand being lifted with each systole
A thrill is a palpable vibration caused by turbulent blood flow through a heart valve (the thrill is a palpable murmur)
You should assess for a thrill across each of the heart valves in turn
To do this place your hand horizontally across the chest wall, with the flats of your fingers and palm over the valve to be assessed
Palpate apex beat
Palpate for parasternal heaves
Palpate for thrills
Auscultate the four valves
A systematic routine will ensure you remember all the steps whilst giving you several chances to listen at each valve area. Your routine should avoid excess repetition whilst each step should ‘build’ upon the information gathered by the previous steps.
1.Palpate the carotid pulse to determine the first heart sound.
2. Auscultate ‘upwards’ through the valve areas using the diaphragm of the stethoscope:
Mitral valve – 5th intercostal space – midclavicular line (apex beat)
Tricuspid valve– 4th or 5th intercostal space – lower left sternal edge
Pulmonary valve– 2nd intercostal space – left sternal edge
Aortic valve– 2nd intercostal space – right sternal edge
3.Repeat auscultation across the four valves with the bell of the stethoscope.
4. Auscultate the carotid arteries with the patient holding their breath to check for radiation of an aortic stenosis murmur (this is known as an accentuation manoeuvre).
5.Sit the patient forwards and auscultate over the aortic area during expiration to listen for the murmur of aortic regurgitation (this is known as an accentuation manoeuvre).
6.Roll the patient onto their left side and listen over the mitral area with the bell during expiration for mitral murmurs (regurgitation/stenosis).
Palpate carotid pulse to whilst auscultating
Auscultate over the mitral valve
Auscultate over the tricuspid valve
Auscultate over the pulmonary valve
Auscultate over the aortic valve
Repeat auscultation using the bell of the stethoscope
Auscultate over the carotid artery listening for radiation of an aortic stenosis murmur
Auscultate over the left sternal edge to better hear an aortic regurgitation murmur
Auscultate over the heart's apex for mitral murmurs
Auscultate into the axilla listening for radiation of mitral murmurs
To complete the examination
Auscultate lung bases:
Crackles may suggest pulmonary oedema (e.g. secondary to left ventricular failure)
Consider chronic lung diseases if the patient has no other signs of fluid overload (e.g. pulmonary fibrosis)
Sacral oedema/pedal oedema – may indicate right ventricular failure