In Cardiovascular examination the most important part are Palpation and Percussion

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.

Cardiovascular examination the most important part are Palpation and Percussion

Percussion of the Heart

• The bare area of the heart i.e. left 3^rd and 4^th 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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