1.         INTRODUCTION
A.        Wash hands with water or alcohol gel.
B.        Introduce self and seek permission to examine the cardiovascular system.
C.        Confirm patient’s name and date of birth.
D.        Ask if patient is currently in any pain.
E.         Position patient at 45 degrees with chest adequately exposed.

2.         GENERAL INSPECTION
A.        Look for signs of breathlessness, discomfort or pain.
B.         Examine face, eyes and mouth for signs of clinical anaemia, cyanosis, xanthelasmata, corneal arcus and malar flush.
C.         Examine hands to assess circulation for warmth and capillary refill. Look for evidence of peripheral cyanosis, nicotine staining,
clubbing, splinter haemorrhages, koilonychia (nail spooning.)

3.         PULSES
A.        Palpate both radial pulses and assess rate and rhythm. Assess for collapsing pulse.
B.        Palpate right carotid pulse and assess volume and character.

4.         JUGULAR VENOUS PULSE ASSESSMENT
A.        Assess right internal jugular vein with patient at 450.  Check for hepatojugular reflux.

5.         INSPECTION AND PALPATION OF PRAECORDIUM
A.        Inspect praecordium (chest) for shape, respiratory rate, scars and visible apex beat.
B.        Palpate praecordium for heaves and thrills. Locate the apex beat and assess character.

6.         AUSCULTATION OF PRAECORDIUM
A.         (Initially whilst palpating the carotid pulse) auscultate the praecordium, for heart sounds and murmurs in all of the 4 key areas.
Use both bell and diaphragm. Position patient on left side and auscultate with bell in expiration.
B.        Auscultate in left axilla for radiation of a murmur, and auscultate carotids for radiation and bruits.
C.        Sit patient forwards. Auscultate in expiration with diaphragm at lower left sternal edge.
D.        Auscultate the lung bases with diaphragm.  Feel for sacral oedema.

7.         OTHER AREAS
A.         Lay patient flat and palpate abdomen for hepato/splenomegaly and aortic pulsation/dilatation. Auscultate for renal and femoral bruits.
B.        Assess for radiofemoral delay. Palpate the femoral, popliteal and foot pulses. Feel for ankle oedema.
C.        Measure and record BP.
D.        Ophthalmoscopic examination. Look for evidence of hypertensive retinopathy.
E.         Test urine with dipstix.
F.         Examine any observation charts available.  Pulse, BP, Temperature, Urine Output.

8.         CONCLUSION
A.        Thank patient and wash hands with alcohol gel or water.
B.        Summarise and present findings orally (and in patient’s notes.)