Synopsis
Perform a safe, reproducible adult cardiovascular examination, link findings to focused investigations and recognise signs that require immediate or time-defined escalation.
- Introduce yourself, confirm identity, obtain consent, ask about pain, position at about 45 degrees and expose from chest to ankles while preserving dignity.
- From the end of the bed assess distress, work of breathing, colour, diaphoresis, body habitus, scars, oxygen, lines and implanted devices.
- In the hands assess temperature, capillary refill, clubbing, splinter haemorrhages and peripheral stigmata, then measure radial pulse rate and rhythm; character is better assessed centrally when safe.
Key red flags
Systolic BP below 90 mmHg with poor perfusion, altered consciousness, cold/mottled skin, oliguria, severe breathlessness or abnormal breathing requires immediate ABCDE/resuscitation rather than completion of the OSCE sequence.
Investigation priorities
Assess chest pain, dyspnoea, syncope, irregular pulse, brady/tachycardia and suspected structural disease.
Management branches
Abnormal responsiveness/breathing, shock, syncope, myocardial ischaemia or severe heart failure associated with arrhythmia.
- Call for help and assess ABCDE with monitoring, IV access and 12-lead ECG without delaying treatment. If unresponsive with abnormal breathing, call 999/resuscitation, start CPR 100–120/min at 5–6 cm and attach AED/defibrillator.
- RCUK 2025/2026 unstable tachyarrhythmia pathway: synchronised cardioversion—AF at maximum device output; atrial flutter/SVT 70–120 J; VT with pulse 120–150 J, escalating if unsuccessful. Sedate or anaesthetise if conscious when this does not cause harmful delay.
The patient is physiologically stable.
Key medicines
Aspirin for suspected ACS300 mg orally as soon as possible, chewed or dispersed when appropriate, unless contraindicated.
Glyceryl trinitrate sublingual sprayGive 1–2 sprays (400–800 micrograms) sublingually initially; if needed, repeat at 5-minute intervals without exceeding 3 sprays total (1.2 mg) in 15 minutes.