Introduces self
0
1

Confirms name & age of patient
0
1

Explains & gains consent
0
1

Washes hands
0
1

Exposes patient from waist up and positions at 45 degrees
0
1

Asks if patient is in pain
0
1

General inspection around bed & patient (breathing, scars, sounds)
0
1

Feels hands for temperature changes, cyanosis, capillary refill time
0
1

Checks hands for nail clubbing, splinter haemorrhages, Janeway lesions, Osler nodes and tar stains
0
1

Feels radial pulse and comments on rate & rhythm
0
1

Asks for blood pressure
0
1

Feels carotid pulse, comments on volume & character
0
1

Checks for water hammer pulse
0
1

Inspects eyes for conjunctival pallor, corneal arcus, xanthelasma and face for malar flush
0
1

Inspects mouth for central cyanosis, dental hygiene, high arched palate
0
1

Assesses and comments on JVP
0
1

Palpates apex beat
0
1

Palpates for heaves & thrills
0
1

Auscultates over mitral area on expiration leaning on left. Listens for radiation in axillary area
0
1

Auscultates over tricuspid area with patient leaning forward on both inspiration and expiration
0
1

Auscultates over pulmonary area on inspiration
0
1

Auscultates over aortic area on expiration and carotids for radiation
0
1

If murmur present comments on intensity, site, character, pitch, radiation
0
1

Listens over lung bases
0
1

Feels for oedema
0
1

Thanks patient and offers help to redress
0
1

Washes hands
0
1

Requests to palpate pulses, ECG, dip urine, fundoscopy
0
1

Summarises appropriately with only key findings
0
1

Offers appropriate differential diagnoses
0
1

Patient global score
0
1
2
Potential differentials
  • Murmurs
    • Aortic stenosis is with slow rising & low volume pulse, narrowed pulse pressure, heaving and sustained apex beat, ejection systolic murmur in aortic area radiating to carotids.
      Differentials:
      • Aortic sclerosis (doesn't radiate to carotids) 
      • Mitral regurgitation (pansystolic radiating to axilla)
      • HOCM (gets quieter on squatting whereas AS gets louder)
    • Aortic regurgitation (rarer) with collapsing pulse, widened pulse pressure, thrusting apex beat, early diastolic murmur in left lower sternal edge
  • Prosthetic valves
    • Aortic valve replacement: midline sternotomy, second heart sound lost with opening click (A2 specifically), can get aortic regurgitation murmur
    • Mitral valve replacement: midline sternotomy OR lateral thoracotomy, S1 lost with opening click, can get mitral regurgitation murmur
    • Look for bruising of anticoagulation
  • Pacemaker/defibrillator 
  • Scars: midline sternotomy with venous grafting scar on leg suggestive of CABG
  • Atrial Fibrillation: look for bruises suggestive of anticoagulation