Palpation of Precordium and Percussion of the Heart

In Cardiovascular examination the most important part are Palpation and Percussion

Palpation of Precordium

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

Cardiovascular examination the most important part are Palpation and Percussion

 

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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