Precardium: Inspection

Slide 1: Precardium: Inspection To identify apex of the heart. To detect enlargement of RV, aorta and pulmonary artery.

Slide 2: Method Of Exam  Inspect the precordium tangentially while the patient is laying flat in bed from either the patient's head or foot for symmetry and pulsations.

Slide 3: Normal:  The precordium is symmetrical.  In thin individuals, the apical impulse is recognizable.  Apical impulse is located in 5th interspace just internal to midclavicular line.  The left precordium will dip slightly during systole.

Slide 4: Abnormal Finding  Bulge  Precordial: Implies onset during childhood ( RV hypertrophy.)  Aortic area bulge:( Aortic aneurysm)

Slide 5: Abnormal Finding  Pulsations  Precordial : RV hyperactivity  Displaced apical impulse: (Cardiac hypertrophy or dilatation, Mediastinal shift, Deformities of thorax, Raised intra-abdominal pressure)  Apical impulse on right: (Dextrocardia)  Aortic:( Aneurysm or dilatation)  Pulmonary: (Pulmonary artery dilatation)  Epigastric: (RV hypertrophy)

Slide 6: Knowledge Base  Anatomy of heart chambers and its relationship to precardium  Apical impulse

Slide 7: Knowledge Base  Pathology of chamber enlargement  Dilated cardiomyopathy (Whole heart, section)

Slide 8: Knowledge Base  Pathology of chamber enlargement  RV hypertrophy (Whole heart, section)

Slide 9: Knowledge Base  Pathology of chamber enlargement  Biventricular hypertrophy (Whole heart, section)

Slide 10: Resources: Bates, A Guide to Physical Exam. “Nurses Information” http://nursesinformations.blogspot.com