Cardiology Examination (OSCE)

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🔍 A cardiac exam is an active process — always think and look for signs systematically rather than waiting for them to appear.

💡 Exam Pearls

• Always state BP would be measured. • Add “I’d like to complete with fundoscopy, urine dip, ECG & echo.” • JVP is best seen with tangential light. • Clubbing + splinter haemorrhages + new murmur = think infective endocarditis. • Always compare both sides: pulses, auscultation areas.

🫀 Complete Cardiac Examination OSCE Guide

👉 The cardiac exam is an active process — you must think, look, and integrate findings systematically. This article combines structured steps, teaching pearls, common findings, and a rapid-revision checklist into one complete resource.

🔑 Principles

• Follow a clear sequence: Inspection → Palpation → Auscultation → Special Maneuvers → Peripheral Signs → Closure.
• Always communicate with the patient and maintain dignity.
• Finish by stating how you’d complete the exam (BP, fundoscopy, urine dipstick, ECG, echo).
• Examiner tip: Talk through your steps. If you forget to do something, verbalising still gains marks. <

1️⃣ Preparation

• 🧼 Wash hands
• 👋 Introduce yourself & confirm patient ID
• 📝 Explain exam, obtain consent
• 🛏️ Position: semi-recumbent (45°), expose chest to waist while maintaining dignity

2️⃣ General Inspection (End of Bed 👀)

• Patient: distress, breathlessness, cyanosis, pallor, cachexia
• Environment: oxygen, nebulisers, GTN spray, IV fluids, ECG leads, mobility aids
• Bedside clues: urine pot (haematuria), sputum pot, fluid balance charts

3️⃣ Hands & Arms ✋

• Inspection: clubbing, splinter haemorrhages, Osler’s nodes, Janeway lesions, tendon xanthomata
• Pulses:
  • Rate & rhythm (AF → irregularly irregular)
  • Character: 🐢 Slow-rising → AS | 💧 Collapsing → AR
  • Radio-radial delay → subclavian stenosis
  • Radio-femoral delay → coarctation of aorta
• BP measurement (mention both arms)

4️⃣ Face & Neck 🙂 & Eyes 👁️

• Eyes: xanthelasma, corneal arcus, conjunctival pallor, Roth spots
• Mouth: cyanosis, poor dentition
• Conjunctival pallor (anaemia), central cyanosis (lips, tongue).
• Xanthelasma / corneal arcus → hyperlipidaemia.
• Malar flush → mitral stenosis. Down’s/Turner’s/Marfan’s facies (syndromic associations).
• Neck: JVP at 45°, hepatojugular reflux, carotid pulse (one side at a time), listen for bruits

Hands ✋

• Clubbing → congenital cyanotic heart disease, endocarditis.
• Splinter haemorrhages, Osler’s nodes, Janeway lesions → endocarditis.
• Nicotine staining, tendon xanthomata, arachnodactyly, joint hypermobility (Marfan/Ehlers-Danlos).
• Temperature (warm/cold), perfusion.

Pulse & Rhythm ❤️

• Rate (brady <60, tachy >100). Count for 15s or full minute if irregular.
• Rhythm: regular / irregularly irregular (AF) / regularly irregular (ectopics, Mobitz II).
• Character: collapsing (AR), slow-rising (AS), jerky (HOCM), bisferiens (mixed AR/AS).
• Compare both radials; check radiofemoral delay (coarctation).

Blood Pressure 💉

• Measure both arms if coarctation/dissection suspected.
• Pulse pressure: narrow (AS), wide (AR, thyrotoxicosis).

5️⃣ Chest Inspection 👕

• Scars: sternotomy, lateral thoracotomy, ICD/PPM bulge
• Deformities: pectus excavatum, scoliosis
• Visible pulsations
• Pacemaker scars (usually L infraclavicular).

6️⃣ Palpation 🤲

• Apex beat: site, size, character, displacement
• Heaves: RV hypertrophy
• Thrills: palpable murmurs

7️⃣ Auscultation 🎧

• Areas (use diaphragm + bell):
  • 🔴 Aortic → 2nd ICS, RSB
  • 🔵 Pulmonary → 2nd ICS, LSB
  • 🟢 Tricuspid → 4th ICS, LSE
  • 🟣 Mitral (apex) → 5th ICS, MCL
  • Axilla → MR radiation
  • Carotids → AS radiation (after bruit check)
• Listen for:
  • S1 & S2 clarity
  • Extra sounds: 💧 S3 (HF, overload), 🔔 S4 (stiff LV)
  • Murmurs: systolic, diastolic, timing, radiation
  • Pericardial rub: scratchy, triphasic

8️⃣ Special Maneuvers ⚡

• Valsalva → ↑ HOCM murmur
• Handgrip → ↑ MR & AR murmurs
• Left lateral decubitus → accentuates MS, S3
• Sit forward + expiration → accentuates AR

9️⃣ Peripheral Signs 👣

• Lung bases → crackles (CCF)
• Sacrum & ankles → oedema
• Legs → saphenous vein harvest scars with sternotomy scar for CABG, varicosities
• Face → malar flush (MS), cyanosis

🔟 Closure 🙏

• Thank patient, assist redressing
• Wash hands again
• Present findings
• State further steps: BP (both arms), fundoscopy, urine dipstick, ECG, echo

Present your findings clearly: “This patient has an ejection systolic murmur loudest in the aortic area, radiating to the carotids, with a slow-rising pulse and narrow pulse pressure — consistent with severe aortic stenosis.” Examiner tip: Even if unsure, structure + reasoning = marks.

💡 Teaching Pearls

• State missing steps you’d add (ECG, echo, fundoscopy, urine dip). • JVP is measured in cm above the sternal angle. • Always comment on scars and environment clues. • Clubbing + splinter haemorrhages + new murmur → think endocarditis. • A collapsing pulse is best felt by raising the arm above the head. • In OSCEs: “I’d like to complete the exam with BP, fundoscopy, urine dip, ECG, echo.” = ✅ marks.

📊 Common Cardiac Examination Findings (Master Table)

Additional Information

📚 References & Further Reading

• Talley & O’Connor – Clinical Examination
• Geeky Medics OSCE Guides
• OSCEstop Resources

📚 References

• Talley & O’Connor – Clinical Examination.
• Geeky Medics OSCE Guides
• OSCEstop resources.