Look at the lips, tongue and nails for the blue discoloration of cyanosis. Cyanosis may be central or peripheral. Inspect the hands for clubbing. Feel the radial pulse at the wrist and note the rate (for example 70/min)and rhythm (regular or irregular). The pulse may be irregular in force as well as time. Check that the other peripheral pulses are present.
Measure the blood pressure. and assess the jugular venous pressure (JVP). Palpate the chest for the apex beat -the normal position isthe fifth left intercostal space, one centimetre medial to the midclavicular line. Feel for any thrills. Heart size may be measured by percussion. Listen for murmurs and other abnormal sounds, for example friction rubs.
beginning at the mitral area. Murmurs may be soft or loud. A harsh murmur is loud and rough.
Note the time of any murmur in relation to the cardiac cycle. The most common murmurs are:
* mid-systolic (in the middle of systole)
* pan-systolic (lasting for the whole of systole)
* early diastolic
* mid-diastolic
* late diastolic (pre-systolic)
Continue by listening at the tricuspid, aortic and pulmonary areas.
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