Cardiovascular examination Inspection End of bed: Have patient lying at 45°. Expose to waist if male, but keep female patients covered until closer inspection. General comments: well, comfortable at rest, body habitus. Cardiorespiratory status: respiratory distress, cyanosis, pallor. Pitting oedema at ankle: press for 5 seconds. Hands: If normal: "hands feel warm and well perfused". Capillary refill: squeeze nailbed for 5 seconds. Should refill in ≤2 seconds. Signs of infective endocarditis (IE): splinter haemorrhages, Osler's nodes, Janeway lesions. Clubbing: cyanotic congenital heart defect, IE, axillary artery aneurysm, atrial myxoma. Tar stains. Wrist: Take radial pulse for 15 seconds and multiply by 4. Report rate, rhythm, and volume. Check for collapsing pulse by lifting arm up, asking first if they have right shoulder pain. A sign of hyperdynamic circulation, seen in aortic regurgitation, anaemia, pregnancy, hypertension, exercise, PDA, AV fistula, and thyrotoxic
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