Home / Complete cardiovascular examination

11-minute physical-examination master page

Complete cardiovascular examination

Perform a safe, focused cardiovascular examination, recognize congestion and valvular findings, present clearly, and state targeted investigations, immediate management and safety-netting.

Candidate instructions

Heart-failure cardiovascular examination station

Your task

Perform a complete focused cardiovascular examination on a 69-year-old patient with dyspnea and ankle swelling. Assess stability first, explain each step, preserve dignity and adapt the examination to symptoms. At the end, present your findings, leading diagnosis, prioritized differential, targeted investigations, immediate management and safety-netting. Do not perform fundoscopy, rectal, genital or breast examination. You have 11 minutes.

Information available at entry

HR 96/min regularBP 148/86 mm HgRR 22/minSpO₂ 93% room air

Safety priority: A focused examination never takes priority over stabilization. If the patient is severely distressed, hypoxemic, hypotensive, confused or poorly perfused, stop the routine sequence, call for help and begin an ABC approach.

What examiners expect

Immediate recognition of instability before a ritual examination.
Professional introduction, two identifiers, explanation, consent and hand hygiene.
Appropriate 30–45-degree positioning without forcing an orthopneic patient flat.
Logical examination of pulse, JVP, precordium, heart sounds, lungs, perfusion and edema.
Selective maneuvers that answer the clinical question rather than an unfocused textbook routine.
A concise findings presentation that integrates severity, diagnosis and dangerous alternatives.
Targeted investigations, immediate management, disposition and clear escalation criteria.

Timed rehearsal

Run the complete station in 11 minutes

Use the timer while a partner follows the standardized-patient findings in Station 27. Finish the patient contact by 9:20, then reserve the final 100 seconds for presentation, investigations, management and safety-netting.

Open full interactive station Review procedure

Station time

11:00

Ready for an 11-minute attempt.

Complete procedure

Exact 11-minute cardiovascular examination sequence

Use the wording as a rehearsal guide, then make it sound natural. The sequence should change immediately when the patient’s stability or symptoms require it.

0:00–0:30

1. Safety glance before touching the patient

Say: “Before I begin, I am checking that you are stable enough for the examination. Are you having chest pain, severe shortness of breath, dizziness or feeling faint right now?”

Observe breathing, colour, mental status, diaphoresis and ability to speak.
Review HR, BP, RR and SpO₂ before beginning.
Stop and escalate immediately if unstable.

0:30–1:05

2. Introduce, identify, explain and obtain consent

Say: “Hello, my name is ____, one of the clinical candidates. Could I confirm your full name and date of birth? I have been asked to examine your heart and circulation. This involves looking, feeling and listening over your chest, neck, abdomen and legs. Is that okay?”

Confirm two identifiers.
Explain the examination in plain language.
Obtain verbal consent and consider a chaperone according to patient preference and local policy.

1:05–1:30

3. Hand hygiene, pain, position and exposure

Say: “I will clean my hands first. Do you have any pain before I begin? I will keep you at about 45 degrees because lying flat may worsen your breathing. I will expose only what is necessary and keep you covered.”

Sanitize hands.
Ask about pain and positional breathlessness.
Position at 30–45 degrees; do not force the patient flat.
Expose the chest appropriately while protecting warmth and dignity.

1:30–2:05

4. General inspection from the end of the bed

Say: “I am first looking for signs of breathing difficulty, circulation problems or fluid retention.”

Assess respiratory effort, colour, distress, body habitus and mentation.
Look for oxygen, monitors, IV lines, mobility aids, chest scars, pacemaker/ICD contour and edema.
Form an early “warm/cold” and “wet/dry” impression without overstating certainty.

2:05–2:50

5. Hands, perfusion, radial pulse and blood pressure

Say: “May I examine your hands and feel your pulse?”

Check temperature, capillary refill, peripheral cyanosis and clubbing.
Look for endocarditis stigmata only when clinically relevant.
Assess radial pulse rate, rhythm, volume and character.
Compare both sides when pulse asymmetry or aortic disease is relevant; state blood-pressure assessment.

2:50–3:15

6. Face and mouth

Say: “I am checking your eyes and lips for signs such as pallor or low oxygen.”

Inspect conjunctivae for pallor.
Inspect lips and tongue for central cyanosis.
Note xanthelasma or corneal arcus only if relevant; do not spend excessive time on minor signs.

3:15–4:20

7. Carotid pulse and jugular venous pressure

Say: “I am going to examine the pulses and veins in your neck. I will press gently on one side at a time.”

Palpate one carotid at a time when indicated; never compress both carotids.
Use tangential lighting and adjust the bed between 30 and 45 degrees.
Identify the top of the internal jugular venous pulsation and measure vertically above the sternal angle.
Describe JVP elevation and waveform when visible.
Use a brief hepatojugular response when volume status remains uncertain.

4:20–5:20

8. Inspect and palpate the precordium

Say: “I will now look at and gently feel the front of your chest to assess the heart’s position and movement.”

Inspect for scars, deformity, devices and visible pulsations.
Locate the apex and describe position and character.
Assess for parasternal heave and thrills over valve areas.
Avoid repeated palpation when the finding is already established.

5:20–6:45

9. Auscultate systematically and use focused maneuvers

Say: “I am going to listen to your heart in several places. Please breathe normally. I may ask you to change position briefly if you are comfortable.”

Listen at aortic, pulmonary, tricuspid and mitral areas with the diaphragm.
Use the bell at the apex for low-pitched sounds such as S3, S4 or mitral stenosis.
Describe rate/rhythm, S1/S2, added sounds and any murmur’s timing, location, grade, radiation and response to maneuvers.
Use left lateral positioning or sitting forward only when it clarifies a suspected finding and the patient tolerates it.

6:45–7:35

10. Examine the lungs for congestion and alternatives

Say: “I also need to listen to your lungs because heart problems can cause fluid to collect there.”

Inspect respiratory pattern and expansion.
Auscultate anterior fields and both posterior/lateral bases.
Identify fine basal crackles, wheeze, reduced air entry or focal bronchial breathing.
Percuss briefly if pleural effusion or another lung process is suspected.

7:35–8:20

11. Check edema and lower-limb perfusion

Say: “I am checking your legs for swelling and circulation.”

Assess bilateral pitting edema and document its level.
Assess lower-limb temperature and pulses if perfusion is uncertain.
Check sacral edema in an immobile patient.
Do not use Homan sign or forcefully squeeze the calves.

8:20–8:55

12. Look for abdominal congestion

Say: “With your permission, I will briefly examine your abdomen for fluid or liver enlargement.”

Palpate gently for hepatomegaly and tenderness.
Assess ascites only when indicated.
Mention weight, urine output and other completion steps rather than performing excluded or low-yield maneuvers.

8:55–9:20

13. Restore comfort and close patient contact

Say: “Thank you. The examination is complete. I will help you sit comfortably and cover you again. Has your breathing or discomfort changed?”

Return the patient upright.
Replace gown/drape and preserve dignity.
Clean hands, thank the patient and reassess symptoms.

9:20–10:05

14. Present the findings

Say: “This patient is mildly tachypneic but alert, warm and hypertensive. The pulse is regular. JVP is elevated with a positive hepatojugular response. The apex is displaced and diffuse. There is an S3 and an apical pansystolic murmur radiating to the axilla. Bibasal crackles, bilateral pitting edema and tender hepatomegaly indicate pulmonary and systemic congestion. There are no clinical signs of shock.”

Use a consistent order: general appearance, pulse/perfusion, JVP, precordium, auscultation, lungs, edema and abdomen.
Include severity and important negatives.
Never invent a finding.

10:05–11:00

15. Diagnosis, investigations, management and safety net

Say: “The leading diagnosis is acute decompensated heart failure, likely ischemic cardiomyopathy with functional mitral regurgitation. I would keep him upright, repeat vital signs, start monitoring and IV access, obtain an ECG, chest radiograph, targeted blood tests and echocardiography, give oxygen only if hypoxemic, treat congestion with monitored loop-diuretic therapy, identify and treat the precipitant, and escalate immediately for worsening hypoxemia, hypotension, confusion, oliguria or cool peripheries.”

Lead with the most likely diagnosis.
Name common and dangerous precipitants.
Link each test to a purpose.
Organize treatment by stability, congestion, precipitant, monitoring, disposition and follow-up.

Interpretation

What important cardiovascular findings mean

Interpret findings in combination. No single sign should be used in isolation to diagnose or grade heart failure.

Finding	Interpretation	OSCE wording
Raised JVP	Elevated right-sided filling pressure; supports systemic congestion when measured correctly.	“The JVP is elevated approximately 5 cm above the sternal angle at 45 degrees.”
Positive hepatojugular response	Sustained rise in JVP during firm abdominal pressure suggests limited right-heart reserve/elevated filling pressure.	“There is a sustained rise in JVP with hepatojugular pressure.”
Displaced, diffuse apex	Suggests left-ventricular enlargement or remodeling.	“The apex is displaced laterally and is diffuse.”
Parasternal heave	Suggests right-ventricular hypertrophy or pressure overload.	“A left parasternal heave is present.”
S3 gallop	Rapid ventricular filling; in an older symptomatic adult it supports volume overload or systolic dysfunction.	“A low-pitched S3 is audible at the apex with the bell.”
Apical pansystolic murmur radiating to axilla	Typical of mitral regurgitation; may be functional in a dilated ventricle.	“There is a grade 3/6 pansystolic murmur maximal at the apex and radiating to the axilla.”
Bibasal fine crackles	Supports pulmonary interstitial fluid but is not specific; consider pneumonia or fibrosis when focal/persistent.	“Fine inspiratory crackles are present at both bases.”
Bilateral pitting edema	Supports systemic fluid retention; interpret with JVP and other signs because venous disease and medications can also cause edema.	“There is bilateral pitting edema to the lower shins.”
Cool peripheries, delayed refill, confusion or oliguria	Possible low-output state or cardiogenic shock; requires urgent escalation.	“There are signs of poor end-organ perfusion, concerning for low cardiac output.”

Focused auscultation

Murmurs and maneuvers worth knowing

Use maneuvers selectively. A breathless patient should not be repeatedly repositioned to demonstrate every possible sign.

Video with sound

Heart murmur check sound lab

Listen to normal S1–S2, aortic stenosis, mitral regurgitation, aortic regurgitation and mitral stenosis. Use headphones, jump between chapters and practise a complete OSCE murmur description.

Open murmur video Review murmur cards

Mitral regurgitation

Sound: Pansystolic at apex, often radiating to axilla.

Maneuver: Left lateral position may improve apical sounds if tolerated.

Clinical link: Functional MR can accompany left-ventricular dilation.

Aortic stenosis

Sound: Ejection systolic at right upper sternal edge, radiating to carotids.

Maneuver: Sit forward if needed; assess carotid upstroke safely.

Clinical link: Ask about exertional syncope, angina and dyspnea.

Aortic regurgitation

Sound: Early diastolic decrescendo at left sternal edge.

Maneuver: Sit forward, full expiration, if tolerated.

Clinical link: Consider bounding pulse and widened pulse pressure.

Mitral stenosis

Sound: Low-pitched mid-diastolic rumble at apex, sometimes with opening snap.

Maneuver: Bell at apex in left lateral position.

Clinical link: Look for atrial fibrillation and pulmonary hypertension.

Hypertrophic cardiomyopathy

Sound: Systolic murmur at left sternal edge.

Maneuver: Often increases with standing or Valsalva and decreases with squatting.

Clinical link: Do not force maneuvers in a symptomatic or unstable patient.

Right-sided murmurs

Sound: Tricuspid regurgitation may increase with inspiration.

Maneuver: Observe respiratory variation while listening at lower left sternal edge.

Clinical link: Integrate with JVP waveform, RV heave and edema.

Examiner presentation

Use a 30–45-second findings summary

“This patient is mildly tachypneic but alert, warm and hypertensive. The pulse is regular. JVP is elevated with a positive hepatojugular response. The apex is displaced and diffuse. There is an S3 and an apical pansystolic murmur radiating to the axilla. Bibasal crackles, bilateral pitting edema and tender hepatomegaly indicate pulmonary and systemic congestion. There are no clinical signs of shock. Overall, this is acute decompensated heart failure on an ischemic cardiomyopathy background, with likely functional mitral regurgitation.”

Presentation order

General and stability: distress, oxygenation, perfusion, blood pressure.
Pulse: rate, rhythm, volume and symmetry.
Neck: JVP and carotid character.
Precordium: apex, heave and thrills.
Auscultation: S1/S2, added sounds and murmur.
Congestion: lungs, edema, liver and ascites.
Interpretation: leading diagnosis, severity and important alternative.

Targeted work-up

Investigations and why you need them

A strong OSCE answer connects each test to a diagnostic or safety question.

Investigation	Purpose	Priority
Repeat vital signs, monitoring and fluid balance	Define severity, rhythm, oxygenation, perfusion and treatment response.	Immediate
12-lead ECG	Identify ischemia, arrhythmia, conduction disease and prior infarction.	Immediate
Chest radiograph	Assess congestion, pleural effusion, cardiomegaly and pulmonary alternatives.	Early
CBC, electrolytes, urea/creatinine, glucose, magnesium and liver tests	Identify anemia, renal dysfunction, electrolyte disturbance and end-organ effects; establish treatment baseline.	Early
High-sensitivity troponin	Assess acute coronary syndrome or myocardial injury when clinically possible.	Early when indicated
BNP or NT-proBNP	Support diagnosis when uncertainty remains; interpret with age, renal function, rhythm and obesity.	Selective
Transthoracic echocardiography	Assess ejection fraction, regional wall motion, chambers, valves and pulmonary pressures.	Early/inpatient
Precipitant-directed testing	Cultures, thyroid testing, PE imaging or other studies only when history/examination supports them.	Targeted

Immediate plan

Management, disposition and safety-netting

State management in a safe order. Specific medication doses depend on the clinical context and local protocol.

1. Stabilize and monitor

Sit upright and repeat complete vital signs.
Establish cardiac/oxygen monitoring and IV access.
Give supplemental oxygen for hypoxemia, not routinely.
Escalate for worsening work of breathing or poor perfusion.

2. Treat congestion

Use loop-diuretic therapy when pulmonary or peripheral congestion is present.
Monitor urine output, weight, renal function and electrolytes.
Consider vasodilator therapy when hypertensive and clinically appropriate.
Reassess symptoms and signs after intervention.

3. Treat the precipitant

Assess ischemia and arrhythmia.
Look for infection, renal dysfunction and uncontrolled blood pressure.
Review medications, adherence, salt/fluid intake and drugs that worsen retention.
Request cardiology/critical-care input when severity requires it.

Urgent escalation: worsening hypoxemia, severe respiratory fatigue, hypotension, cool peripheries, delayed capillary refill, confusion, chest pain, malignant arrhythmia, oliguria or rising lactate should trigger immediate senior/emergency/critical-care assessment.

Safety-net before discharge: worsening breathlessness at rest, syncope, chest pain, rapid weight gain, reduced urine output or inability to take medication requires urgent reassessment. Confirm medication reconciliation, daily-weight instructions, follow-up and patient understanding.

All pages connected

Continue through the linked cardiovascular pathway

The master page is linked from the global header, footer, home page, physical-examination module, OSCE skills page, station library, site map and XML sitemap.

11-minute examination

Reference starting points

Educational preparation only. Clinical care must follow current patient-specific assessment and local protocols.

Complete cardiovascular examination

Heart-failure cardiovascular examination station

What examiners expect

Run the complete station in 11 minutes

Exact 11-minute cardiovascular examination sequence

1. Safety glance before touching the patient

2. Introduce, identify, explain and obtain consent

3. Hand hygiene, pain, position and exposure

4. General inspection from the end of the bed

5. Hands, perfusion, radial pulse and blood pressure

6. Face and mouth

7. Carotid pulse and jugular venous pressure

8. Inspect and palpate the precordium

9. Auscultate systematically and use focused maneuvers

10. Examine the lungs for congestion and alternatives

11. Check edema and lower-limb perfusion

12. Look for abdominal congestion

13. Restore comfort and close patient contact

14. Present the findings

15. Diagnosis, investigations, management and safety net

What important cardiovascular findings mean

Murmurs and maneuvers worth knowing

Heart murmur check sound lab

Mitral regurgitation

Aortic stenosis

Aortic regurgitation

Mitral stenosis

Hypertrophic cardiomyopathy

Right-sided murmurs

Use a 30–45-second findings summary

Presentation order

Investigations and why you need them

Management, disposition and safety-netting

1. Stabilize and monitor

2. Treat congestion

3. Treat the precipitant

Complete cardiovascular examination checklist

Continue through the linked cardiovascular pathway

Complete heart-failure cardiovascular station

Chest pain with focused cardiac and respiratory examination

Palpitations followed by syncope

Physical Examination

Internal Medicine

OSCE Skills Frameworks

Reference starting points