45 care giver's lap alert conscious no respiratory distress pallor cyanosed dysmorphic features RR HR Temperature SPO2 BP CRT radial pulse radio radial delay collapsing pulse carotid pulse femoral pulse radio femoral delay peripheral pulses pallor jaundice xanthelesma corneal arcus central cyanosis oral hygiene malar flush JVP thyroid swelling webbed neck clubbing peripheral cyanosis splinter hemorrhage osler nodes janeway lesions palmar erythema pitting edema scars deformities pericordial bulge visible apex beat apex beat parasternal heave thrills s1,s2 added sounds murmurs pericardial rub carotid bruits crepitations lung hepatomegaly ascites hepatojugular reflex pedal edema sacral edema how to comment on it based on the cvs examination. postive and negative comment. make a table
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Use this as a CVS examination comment sheet. Record what is actually found. Do not state both positive and negative for the same sign.
If this is a young child sitting on a caregiver’s lap, document the child’s age and assess pulses, cyanosis, respiratory distress, hepatomegaly and oedema carefully. JVP is often difficult to assess reliably in infants and small children.
| Area | Negative / normal comment | Positive / abnormal comment and possible significance |
|---|---|---|
| General appearance | “Patient is alert, conscious, comfortable at rest and not in respiratory distress.” | “Patient is irritable/lethargic/drowsy, tachypnoeic, or in respiratory distress with retractions.” |
| Position / caregiver lap | “Child is comfortable on the caregiver’s lap.” | “Child prefers upright position / is unable to feed or lie flat,” which can suggest heart failure or respiratory compromise. |
| Build and facies | “No dysmorphic features.” | “Dysmorphic facies present, including ___.” Describe rather than label. May support a syndromic congenital heart disease. |
| Pallor | “No pallor.” | “Pallor present.” Consider anaemia, chronic illness or poor perfusion. |
| Cyanosis | “No central or peripheral cyanosis.” | “Central cyanosis present,” seen on tongue and oral mucosa, suggests reduced arterial oxygen saturation. “Peripheral cyanosis present” affects fingers/toes and may occur with cold exposure or poor perfusion. |
| Vital signs | “RR ___/min, HR ___/min regular, temperature ___ °C, SpO₂ ___% on room air, BP ___ mmHg, all appropriate for age.” | State actual abnormality: “Tachypnoeic,” “tachycardic,” “febrile,” “hypoxic,” “hypertensive/hypotensive.” Interpret using age-specific normal ranges. |
| Capillary refill time | “CRT is <2 seconds.” | “CRT is prolonged at ___ seconds,” suggesting reduced peripheral perfusion. |
| Radial pulse | “Radial pulses are equal bilaterally, regular, of normal volume and character.” | “Pulse is weak/thready,” “bounding,” “irregularly irregular,” or “low volume.” |
| Radio-radial delay | “No radio-radial delay.” | “Radio-radial delay present,” suggesting proximal upper-limb arterial obstruction or aortic arch disease. |
| Collapsing pulse | “No collapsing pulse.” | “Collapsing/water-hammer pulse present.” May occur in aortic regurgitation or high-output states. |
| Carotid pulse | “Carotid pulse is normal in volume and character.” | “Slow-rising carotid pulse” may occur in aortic stenosis; “bounding carotid pulse” may occur in aortic regurgitation. Examine one side at a time. |
| Femoral pulses | “Femoral pulses are palpable, equal and normal in volume.” | “Femoral pulses are weak/absent/delayed.” This is important in suspected coarctation of the aorta. |
| Radio-femoral delay | “No radio-femoral delay.” | “Radio-femoral delay present,” classically suggesting coarctation of the aorta. |
| Other peripheral pulses | “All peripheral pulses are palpable and symmetrical.” | “Dorsalis pedis/posterior tibial pulses are reduced or absent.” |
| Jaundice | “No icterus.” | “Icterus present.” This is not usually a primary CVS sign but may indicate hepatic or haemolytic disease. |
| Xanthelasma / corneal arcus | “No xanthelasma or corneal arcus.” | “Xanthelasma/corneal arcus present,” which may suggest dyslipidaemia, particularly if premature. |
| Oral cavity | “No central cyanosis; oral hygiene is satisfactory.” | “Central cyanosis present on the tongue/oral mucosa.” “Poor dentition/oral hygiene” increases infective endocarditis risk in susceptible patients. |
| Malar flush | “No malar flush.” | “Malar flush present,” a classic association of severe mitral stenosis. |
| JVP | “JVP is not elevated.” In adults, a normal JVP is generally ≤3 cm above the sternal angle at 45°. | “JVP is elevated at ___ cm.” May indicate right-sided heart failure, fluid overload, pulmonary hypertension, constrictive pericarditis or tamponade. |
| Hepatojugular reflux | “Hepatojugular reflux is negative.” | “Sustained positive hepatojugular reflux present,” supporting raised right-sided filling pressures. |
| Thyroid | “No thyroid swelling.” | “Thyroid enlargement present.” Hyperthyroidism may cause tachycardia, atrial fibrillation or a high-output state. |
| Neck | “No webbed neck.” | “Webbed neck present.” Can be associated with Turner syndrome and coarctation of the aorta. |
| Clubbing | “No digital clubbing.” | “Digital clubbing present.” May occur in cyanotic congenital heart disease or infective endocarditis. |
| Splinter haemorrhages | “No splinter haemorrhages.” | “Splinter haemorrhages present.” They are non-specific but can occur in infective endocarditis. |
| Osler nodes | “No Osler nodes.” | “Tender Osler nodes present on finger/toe pads,” a peripheral manifestation of infective endocarditis. |
| Janeway lesions | “No Janeway lesions.” | “Non-tender Janeway lesions present on palms/soles,” a peripheral manifestation of infective endocarditis. |
| Palmar erythema | “No palmar erythema.” | “Palmar erythema present.” It is non-specific and may occur with liver disease or high-output states. |
| Peripheral oedema | “No pitting pedal oedema.” | “Bilateral pitting pedal oedema up to ___.” Supports fluid overload/right heart failure in the appropriate context. |
| Sacral oedema | “No sacral oedema.” | “Sacral oedema present,” especially useful in bed-bound patients or infants with fluid overload. |
| Scars / deformities | “No sternotomy, thoracotomy, pacemaker or chest-drain scars; no chest-wall deformity.” | “Midline sternotomy scar present,” suggesting previous cardiac surgery. Describe other scars or deformities precisely. |
| Precordial inspection | “No precordial bulge or visible pulsations.” | “Precordial bulge / visible apex beat / abnormal precordial pulsation present.” In children, a precordial bulge can suggest longstanding cardiomegaly. |
| Apex beat | “Apex beat palpable in the 5th left intercostal space, mid-clavicular line, normal in character.” In younger children, location varies with age. | “Apex beat displaced laterally/inferiorly,” suggesting cardiomegaly. “Heaving” suggests pressure overload; “hyperdynamic” suggests volume overload/high-output state. |
| Parasternal heave | “No parasternal heave.” | “Left parasternal heave present,” suggesting right ventricular hypertrophy or pulmonary hypertension. |
| Thrills | “No palpable thrills.” | “Systolic/diastolic thrill palpable at ___ area.” A thrill generally indicates a loud murmur. |
| Heart sounds | “S1 and S2 are normal, with no added sounds.” | “Loud P2,” “fixed split S2,” “single S2,” “S3/S4 gallop,” or “opening snap” should be described with timing and site. |
| Murmur | “No murmur heard.” | State: “A grade ___/6, ___ systolic/diastolic/continuous murmur, maximal at ___, radiating to ___, with ___ character.” A diastolic murmur is pathological until proven otherwise. |
| Pericardial rub | “No pericardial rub.” | “A scratchy pericardial friction rub heard,” supporting pericarditis. |
| Carotid bruits | “No carotid bruits.” | “Carotid bruit heard over the ___ carotid.” This may indicate turbulent flow, often from carotid stenosis. |
| Lungs | “Bilateral air entry is equal; no basal crepitations.” | “Bibasal fine crepitations present,” which may suggest pulmonary congestion/left-sided heart failure. |
| Abdomen | “Abdomen is soft; no hepatomegaly or ascites.” | “Tender/non-tender hepatomegaly ___ cm below right costal margin” may occur in right heart failure. “Ascites present” may reflect systemic venous congestion. |
Example normal CVS examination comment
The patient is alert, conscious and comfortable at rest, with no respiratory distress. There is no pallor, central or peripheral cyanosis, dysmorphic facies or peripheral stigmata of infective endocarditis. Vital signs are appropriate for age, with normal oxygen saturation. CRT is less than 2 seconds. Peripheral pulses are well felt, equal and regular, with no radio-radial or radio-femoral delay.JVP is not elevated. There is no pedal or sacral oedema. The precordium is normal, with no scars, bulge, visible pulsations, parasternal heave or thrills. Apex beat is in the normal position and character. S1 and S2 are normal, with no added sounds, murmurs or pericardial rub. There are no carotid bruits. Lung fields are clear, and there is no hepatomegaly, ascites or positive hepatojugular reflux.Overall, CVS examination is within normal limits.
Example positive CVS examination comment
The patient is tachypnoeic with central cyanosis and an SpO₂ of ___% on room air. CRT is ___ seconds. Radial pulses are normal, but femoral pulses are weak and delayed, with radio-femoral delay. There is a left parasternal heave and a systolic thrill at the left upper sternal border. S2 is loud, and there is a grade ___/6 ejection systolic murmur, maximal at ___ with radiation to ___.There are bibasal crepitations, hepatomegaly of ___ cm and bilateral pitting pedal oedema.These findings suggest ___; correlate with ECG, chest radiograph and echocardiography.
A normal summary structure like this is consistent with standard OSCE CVS examination sequencing, including JVP, apex beat, heart sounds, oedema and lung assessment, as described in this CVS examination guide.
when u put - in the places. u have to give the options to fill also
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Yes. Instead of writing only blanks such as “murmur: ___”, write the possible options beside the blank so you know what to fill in.
CVS examination comments with fill-in options
| Finding | How to write it | Options to choose from |
|---|---|---|
| General condition | Child is ___ on caregiver’s lap. | alert / conscious / irritable / lethargic / drowsy / crying but consolable |
| Respiratory distress | Child is with / without respiratory distress. | no distress / tachypnoea / chest retractions / nasal flaring / grunting / unable to feed |
| Pallor | Pallor is ___. | absent / mild / moderate / severe |
| Cyanosis | Cyanosis is ___. | absent / central cyanosis present / peripheral cyanosis present / both central and peripheral cyanosis |
| Dysmorphic features | Dysmorphic features are ___. | absent / present: low-set ears / webbed neck / upslanting palpebral fissures / short stature / other ___ |
| Respiratory rate | RR is /min, which is ** for age**. | normal / tachypnoeic / bradypnoeic |
| Heart rate | HR is /min, rhythm is ****. | regular / irregularly irregular / regularly irregular; normal for age / tachycardic / bradycardic |
| Temperature | Temperature is ___ °C. | afebrile / febrile / hypothermic |
| SpO₂ | SpO₂ is % on ****. | room air / nasal oxygen / face mask / non-rebreathing mask |
| Blood pressure | BP is / mmHg, ___ for age. | normal / hypotensive / hypertensive |
| CRT | CRT is ___ seconds. | <2 seconds / 2-3 seconds / >3 seconds |
| Radial pulse | Radial pulse is ___, with ___ volume. | regular / irregular; normal volume / low volume / thready / bounding |
| Radio-radial delay | Radio-radial delay is ___. | absent / present |
| Collapsing pulse | Collapsing pulse is ___. | absent / present |
| Carotid pulse | Carotid pulse is ___. | normal / slow-rising / bounding / weak |
| Femoral pulse | Femoral pulses are ___ bilaterally. | well felt / weak / absent / unequal |
| Radio-femoral delay | Radio-femoral delay is ___. | absent / present |
| Peripheral pulses | All peripheral pulses are ___. | palpable and equal / weak / absent / asymmetrical |
| Jaundice | Icterus is ___. | absent / present |
| Xanthelasma | Xanthelasma is ___. | absent / present |
| Corneal arcus | Corneal arcus is ___. | absent / present |
| Central cyanosis | Central cyanosis is ___. | absent / present over tongue and oral mucosa |
| Oral hygiene | Oral hygiene is ___. | good / fair / poor / dental caries present |
| Malar flush | Malar flush is ___. | absent / present |
| JVP | JVP is ___. | not elevated / elevated / not assessed due to child’s age or poor cooperation |
| Thyroid swelling | Thyroid swelling is ___. | absent / present |
| Webbed neck | Webbed neck is ___. | absent / present |
| Clubbing | Clubbing is ___. | absent / present, grade 1 / 2 / 3 / 4 |
| Peripheral cyanosis | Peripheral cyanosis is ___. | absent / present in fingers / toes / both |
| Splinter haemorrhages | Splinter haemorrhages are ___. | absent / present |
| Osler nodes | Osler nodes are ___. | absent / present |
| Janeway lesions | Janeway lesions are ___. | absent / present |
| Palmar erythema | Palmar erythema is ___. | absent / present |
| Pitting oedema | Pitting oedema is ___. | absent / present, mild / moderate / severe; up to ankle / shin / knee |
| Scars | Scars are ___. | absent / median sternotomy scar / left thoracotomy scar / right thoracotomy scar / pacemaker scar / drain scar |
| Deformities | Chest wall deformity is ___. | absent / pectus carinatum / pectus excavatum / scoliosis / other ___ |
| Precordial bulge | Precordial bulge is ___. | absent / present |
| Visible apex beat | Visible apex beat is ___. | not visible / visible in normal position / visible and displaced |
| Apex beat position | Apex beat is felt at ___, and is ___. | 4th/5th left intercostal space; midclavicular line / displaced laterally / displaced inferiorly; normal / heaving / hyperdynamic |
| Parasternal heave | Parasternal heave is ___. | absent / present |
| Thrill | Thrill is ___. | absent / systolic thrill / diastolic thrill; at apex / left lower sternal border / left upper sternal border / right upper sternal border |
| S1 and S2 | S1 and S2 are ___. | normal / loud S1 / soft S1 / loud P2 / single S2 / wide split S2 / fixed split S2 |
| Added sounds | Added sounds are ___. | absent / S3 present / S4 present / opening snap / ejection click |
| Murmur | A ___ murmur of grade /6 is heard at ****, with radiation to ___. | systolic / diastolic / continuous; ejection systolic / pansystolic / early diastolic / mid-diastolic; apex / left lower sternal border / left upper sternal border / right upper sternal border; axilla / carotids / back / no radiation |
| Pericardial rub | Pericardial rub is ___. | absent / present |
| Carotid bruit | Carotid bruit is ___. | absent / present on right / present on left / bilateral |
| Lung crepitations | Crepitations are ___. | absent / bibasal fine crepitations / right basal / left basal / bilateral diffuse crepitations |
| Hepatomegaly | Liver is palpable ___ cm below the right costal margin and is ___. | not palpable / 1-2 cm / 3-5 cm / >5 cm; soft / firm / tender / non-tender |
| Ascites | Ascites is ___. | absent / present |
| Hepatojugular reflux | Hepatojugular reflux is ___. | negative / positive / not assessed |
| Pedal oedema | Pedal oedema is ___. | absent / bilateral pitting / unilateral pitting / non-pitting; mild / moderate / severe |
| Sacral oedema | Sacral oedema is ___. | absent / present |
Ready-to-use normal CVS comment
Child is alert, conscious and comfortable on the caregiver’s lap, with no respiratory distress. There is no pallor, jaundice, central or peripheral cyanosis, dysmorphic features, clubbing, splinter haemorrhages, Osler nodes or Janeway lesions.RR is ___/min, HR is ___/min and regular, temperature is ___°C, SpO₂ is ___% on room air, and BP is / mmHg, all appropriate for age. CRT is less than 2 seconds. Radial, femoral and all peripheral pulses are well felt, equal and regular, with no radio-radial or radio-femoral delay.JVP is not elevated/not assessed. There is no precordial bulge, visible apex beat, parasternal heave or thrill. Apex beat is in the appropriate position for age and normal in character. S1 and S2 are normal, with no added sounds, murmur or pericardial rub. Lungs are clear, with no crepitations. There is no hepatomegaly, ascites, pedal oedema or sacral oedema.CVS examination is within normal limits.
Ready-to-use positive comment format
Child is alert/conscious/irritable/lethargic and is with/without respiratory distress. Pallor is absent/present. Central cyanosis is absent/present, with SpO₂ ___% on room air.HR is ___/min and regular/irregular. Peripheral pulses are normal/weak/bounding. Femoral pulses are well felt/weak/absent, with radio-femoral delay absent/present.Precordial bulge is absent/present. Apex beat is at ___ and is normal/heaving/hyperdynamic. Parasternal heave is absent/present. A grade ___/6 systolic/diastolic/continuous murmur is heard best at ___ and radiates to ___.There are no/bibasilar crepitations. Liver is not palpable/palpable ___ cm below the right costal margin. Pedal and sacral oedema are absent/present.
For a young child, always compare heart rate, respiratory rate and blood pressure with age-specific normal values, not adult ranges.
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