Cardiac Exam and Vitals
The high-yield cardiovascular exam and vitals that actually change cardiology decisions.
Learning Objectives
- 1.Obtain and interpret the vitals that matter in cardiology.
- 2.Perform a focused cardiovascular exam.
- 3.Recognize the high-yield findings of volume overload, perfusion, and valve disease.
- 4.Know which exam findings demand escalation.
Overview
You don’t need a cardiologist’s ear for everything — you need to reliably assess volume status, perfusion, rhythm, and the few exam findings that change management. Pair the exam with the right vitals and it becomes powerful.
Vitals that matter
- •Blood pressure — correct technique; both arms on a dissection/PAD concern (significant differential matters).
- •Orthostatic vitals when syncope/volume questions arise.
- •Heart rate and rhythm (regular vs irregular) — count irregular pulses fully.
- •Oxygen saturation; respiratory rate.
- •Weight and trend — the single best volume marker in heart failure.
The focused CV exam
- •JVP / JVD — estimate central venous pressure; elevated suggests congestion.
- •Carotids — upstroke and bruits.
- •Precordium — PMI location/displacement; heaves/thrills.
- •Heart sounds — S1/S2; S3 (volume overload/HF), S4 (stiff ventricle); murmurs (timing, location, radiation).
- •Lungs — bibasilar crackles (pulmonary congestion).
- •Extremities — peripheral edema (and symmetry), pulses, temperature/perfusion, capillary refill.
Congestion vs perfusion (the HF lens)
- •Congestion ("wet"): elevated JVP, crackles, edema, orthopnea.
- •Perfusion ("cold"): narrow pulse pressure, cool extremities, altered mentation, hypotension.
- •This wet/dry–warm/cold framing drives heart-failure decisions.
High-yield murmur basics
- •Systolic, harsh, RUSB radiating to carotids → aortic stenosis (exertional syncope/angina/dyspnea concern).
- •Holosystolic at apex radiating to axilla → mitral regurgitation.
- •Use exam to recognize and route to echo — not to grade severity definitively.
Red flags on exam
- •Hypotension with cool extremities / poor perfusion (shock).
- •Hypoxia with diffuse crackles (pulmonary edema).
- •A significant inter-arm BP differential with chest/back pain (dissection).
- •New harsh murmur with exertional syncope (severe AS).
Escalate
Signs of hypoperfusion/shock or florid pulmonary edema are emergencies — stabilize and get the physician immediately.
Common beginner mistakes
- •Trusting a single automated BP without rechecking a surprising value.
- •Missing elevated JVP because of positioning/technique.
- •Over-interpreting a soft flow murmur, or ignoring a concerning one.
- •Not weighing the heart-failure patient.
Documentation pearls
- •Document volume status (JVP, edema, lungs) and perfusion explicitly.
- •Describe murmurs by timing/location/radiation; note the action (e.g., echo ordered).
Nurse / MA workflow connection
- •Accurate MA vitals and weight are the foundation — verify surprising values yourself.
- •Ask the MA to pre-load weights/orthostatics for the relevant visit types.
Mini cases
A heart-failure patient has elevated JVP, bibasilar crackles, 2+ pitting edema, BP 150/90, warm extremities.
Wet/dry and warm/cold?
Show answer
Wet and warm — congested but well-perfused. This typically points toward decongestion (diuresis) and outpatient or floor management, not shock — but confirm and escalate per severity.
BP 86/60, cool mottled extremities, confusion, faint pulses in a dyspneic patient.
What does the exam tell you?
Show answer
Hypoperfusion/possible cardiogenic shock — "cold." This is an emergency: stabilize and escalate to the physician immediately; do not manage as routine.