Always begin the examination by introducing yourself and ask the patient if they have any pain in the part of the body that you are about to examine. This avoids unnecessary patient discomfort.

Examination of the ischaemic arm

Exposure and positioning: expose and position the patient's arms and chest. Patient may be sitting or lying down.

INSPECTION

General inspection for:

1. ▪ Signs of cardiovascular disease

2. ▪ Respiratory rate (dyspnoea)

3. ▪ Scars from previous cardiovascular surgery

4. ▪ Pallor.

Inspect hands for:

1. ▪ Nicotine-stained nails

2. ▪ Clubbing

3. ▪ Vasculitic lesions

4. ▪ Finger pulp wasting

5. ▪ Skin changes

6. ▪ Colour (pallor, cyanosis).

PALPATION

1. ▪ Feel the temperature of both arms with the back of your hands.

2. ▪ Measure nail-bed capillary refill (normally < 2 s).

3. ▪ Feel radial pulses for rate, character, and rhythm. Look for radioradial delay (coarctation of aorta) and a collapsing pulse (aortic regurgitation) by raising the patient's armabove the level of their shoulder. Apply mild traction on shoulder to see if radial pulse collapses (indicates a cervical rib).

4. ▪ Feel brachial pulse.

5. ▪ Feel for axillary pulse (if palpable may be abnormal).

6. ▪ Feel for subclavian pulse in supraclavicular fossa (if palpable may be abnormal). Also you may feel a cervical rib here.

7. ▪ Feel the carotid pulses.

AUSCULTATION

Listen for bruits over carotid and subclavian arteries.

COMPLETE THE EXAMINATION

By:

1. ▪ Measuring the blood pressure in both arms

2. ▪ Performing a full neurological examination

3. ▪ Performing a full cardiovascular examination.