Cardiovascular Examination

Any examination of the respiratory system should include at least a limited examination of the cardiovascular system. With the patient lying back at 45°, assess for signs of cor pulmonale; an elevated jugular venous pressure, peripheral oedema, and signs of pulmonary artery hypertension; large v waves in the JVP, a right ventricular heave and a loud pulmonary component of the second heart. Palpate for the cardiac apex which may be displaced in left ventricular enlargement, impalpable with significant pulmonary hyperinflation or on the right side of the chest in dextrocardia (associated with Kartagener’s Syndrome).

Palpate the upper abdomen. The liver edge may be felt below the costal margin due either to ptosis of the liver from hyperinflation of the lungs or hepatomegaly from congestion secondary to right heart failure.