How to examine the heart and circulation
Other platforms explain it with text and video. In VMS you practice it on the patient.
The cardiovascular exam follows look, feel, listen. Stanford Medicine 25 and the open nursing textbooks use the same order, from the hands to the heart.
Step by step
Prepare
Clean your hands, introduce yourself, get consent, position the patient at 45 degrees and expose the chest with a drape. [1]
General look and hands
Breathlessness, color, and the hands: temperature, color, clubbing and capillary refill. [1]
Pulses and blood pressure
Radial pulse rate and rhythm, compare both sides, then blood pressure. [1]
Neck
Look at the jugular vein height at 45 degrees. Feel one carotid at a time, never both, and listen for a bruit. [2]
Look and feel the chest
Scars, visible pulsations. Find the apex beat (normally fifth intercostal space, midclavicular line) and feel for heaves and thrills. [1]
Listen
Diaphragm, then bell, at the aortic (2nd right intercostal space), pulmonic (2nd left), tricuspid (4th left, lower sternal border) and mitral (5th, midclavicular) areas. Time sounds with the carotid pulse. [2]
Extra positions
Left side for mitral sounds; sitting forward, breath held after breathing out, for aortic regurgitation. [2]
Finish
Listen to the lung bases, check for swelling at the ankles and sacrum, cover the patient and explain the findings. [1]
Common errors
- Pressing both carotids at the same time.
- Listening through clothing.
- Not timing murmurs with the pulse.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
- Stanford Medicine 25 (bedside exam)
- AAMC Core Entrustable Professional Activities (Core EPAs)
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow Stanford Medicine 25 (bedside exam); AAMC Core Entrustable Professional Activities (Core EPAs). VMS is not affiliated with these organizations. Updated: 2026-10-11.