In Cardiovascular examination the most important part are Palpation and Percussion
Palpation of Precordium
- The location, amplitude and character of cardiac impulse is noted.
- The normal LV apex is located in left fifth intercostal space in the midclavicular line. Normal apex is a systolic outward thrust which is localized and less than 2.5 cm in diameter.
- In cases of LV enlargement the impulse is shifted laterally and downwards.
- An additional impulse is seen superior and medial to apex in mitral regurgitation (MR), myocardial infarction (M!), hypertrophic cardiomyopathy.
- RVH is seen as sustained systolic lift in the lower left parasternal area, or parasternal heave or epigastric pulsations felt at the tip of finger placed in the epigastrium.
- Pulsation of right sternoclavicular joint is seen in aortic aneurysm of arch or ascending aorta.
- Pulmonary artery pulsation is visible and palpable in left second intercostal space in pulmonary hypertension and in normal thin young adults.
- Thrills are palpable murmurs found in MS, MR and AS at the site of murmurs.
Percussion of the Heart
- The bare area of the heart i.e. left 3rd and 4th intercostal spaces are dull on superficial or light percussion (superficial cardiac dullness). The rest of the heart is dull on deep percussion only, due to it being covered by lung tissue (deep cardiac dullness).
- The heart can be outlined by percussion from resonance to dullness.
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