ABSTRACT

Z From the end of the couch, observe the patient’s general appearance (age, state of health, nutritional status, and any other obvious signs). Is the patient breathless or cyanosed?

Z Inspect the precordium for the presence of any abnormal pulsation and the chest for any scars. A median sternotomy might have been performed for coronary artery bypass grafting, for valve surgery, or for the repair of a congenital defect. Don’t miss a pacemaker if it is there!