physical examination of cardiovascular system

abdomen:
pulsatile, expansible abdominal, mass: aortic aneurysm
large, tender liver: heart failure, constrictive pericarditis
systolic hepatic pulsation: TR
palpable spleen: severe heart failure, infective endocarditis
ascites: heart failure, constrictive heart failure (especially when ascites is out of proportion of limbs edema)

extremities:
ankle-brachial index (ABI): consider to be abnormal when <0.9, critical stenosis when < 0.3
thrombophlebitis: pain in the calf or thigh, with edema

arterial pressure pulse:

pulsus parvus: small weak pulse, common condition with decreased cardiac output

pulsus tardus: delayed systolic pulse, severe AS

pulsus bisferiens: two systolic peak, AR, or hypertrophic cardiomyopathy 

pulsus alternans: regular rhythm with regular alternation of the pressure pulse amplitude, severe impairment of

                          LV function

pulsus paradoxus: systolic pressure decreased> 10 mmHg when inspiration, cardiac temponade, severe

                            lung disease, severe vena cava obstruction

a: atrial contraction 

c: TV bulging into RA when RV isovolumetric systole 

x: atrial relaxation when RV contraction 

v: right atrial volume increased when RV systole and TV close 

y: RV pressure decline and TV open

abdominal-jugular reflex: increased upper level of venous pulsation when abdominal compression (>10 seconds), indicate heart failure or TR

Kussmaul sign: increased rather than decreased CVP level during inspiration, indicate severe right-heart

                       failure

Precordial palpation:

normal LV apex impulse: mid-clavicular line, 4th or 5th intercostal space

LV hypertrophy: lateral and downward displacement of LV apex impulse 

RV hypertrophy: sustained systolic lift at lower left sternal border 

MR: left parasternal lift due to RV anterior displacement (compressed by enlarged LA)

visible or palpable pulmonary flow over the left 2nd intercostal space: pulmonary hypertension