2. Listen for any mechanical heart valve

3. Feel the pulse for rate and character

4. Palpate for apex beat and feel for ventricular lift

5. Auscultation ( with both diaphragm and bell and with the patient turning to one 
    side or sit forward)

6. Listen to the base of lungs for pulmonary oedema

7. Check ankle oedema

8. Mention you like to check the blood pressure
 

Most cases have vascular diseases involving the eye or the visual pathway. Therefore, look for abnormal rhythm and left sided valvular disorders. The most likely cases are:

•         atrial fibrillation
•         mitral stenosis
•         mitral incompetence
•         aortic stenosis
•         aortic incompetence
•         a mixture of the above
•         mechanical heart valve
•         Marfan's syndrome with aortic incompetence
•         carotid stenosis