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Precardium: Palpation
 

Precardium: Palpation

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To evaluate apical impulse. To assess dilatation and dynamics of RV, aorta and pulmonary artery.

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    Precardium: Palpation Precardium: Palpation Presentation Transcript

    • Precardium: Palpation To evaluate apical impulse. To assess dilatation and dynamics of RV, aorta and pulmonary artery.
    • Method Of Exam
      • Palpate the precordium with the palmar surface of your hand over the aortic, pulmonary, parasternal and apical areas of the heart.
    • Method Of Exam
      • Determine the lower and outermost precardiac impulse, the apical impulse .
    • Method Of Exam
      • Press your finger over the apical impulse identify its location, amplitude, duration and assess the rapidity of the upstroke and downstroke.
    • Normal:
      • In thin individuals, the apical impulse is recognizable. Apical impulse is normally in 5th interspace just medial to midclavicular line and is about 1-2 cm in diameter . The apical impulse feels like a gentle tap and is small in amplitude and corresponds to first two thirds of systole.
    • Abnormal Finding
      • Bulge: Note the site of bulge.
            • Precordial bulge : RV hypertrophy, LA enlargement, LV aneurysm
            • Aortic area bulge : Aortic aneurysm, Dilation (e.g., post stenotic dilation)
    • Abnormal Finding
      • Thrust: Note the site, size, amplitude , duration, upstroke and downstroke characteristics.
          • Parasternal area :
              • Marked increase in amplitude with little change in duration; Volume overload of RV (ASD)
              • Marked increase in amplitude and duration; Pressure overload of RV (Pulmonic stenosis, Pulmonary hypertension)
          • Aortic area : ( Aortic aneurysm)
          • Pulmonic area : Prominent pulsation (Pulmonary artery dilatation ,Increased flow , Pulmonary hypertension)
          • Apical impulse
              • Sustained lift : Pressure overload, LV hypertrophy ( Aortic stenosis)
              • Hyperdynamic : Marked increase in amplitude Volume overload (Mitral insufficiency, Aortic insufficiency)
              • Undetectable apical impulse: (Obesity, Emphysema, Muscular chest, Pericardial effusion)
              • Hypokinetic apical impulse and displaced to left:(Dilated failing Heart)
      • Thrill: It is a purring sensation. Note its location and timing.
          • Parasternal area : (PDA, ASD, VSD)
          • Aortic area : ( Aortic stenosis)
          • Pulmonic area : ( Pulmonary stenosis)
          • Apical area : ( Mitral insufficiency, Mitral stenosis)
      • Tap : Loud sounds evoke a palpable feeling like a tap.
          • Aortic area : Palpable A2 ( Hypertension)
          • Pulmonic area : Palpable P2 ( Pulmonary hypertension)
      • Rub : Scratchy feeling.
          • ( Pericardial)
      • Szorsy Gallops: Can be palpable
    • Knowledge Base
      • Anatomy of heart chambers and its relationship to precardium
      • Apical impulse
      • Conditions causing different chamber enlargement
    • Knowledge Base
      • Physiology of cardiac function
      • Surface anatomy of valves and major vessels
      • Hemodynamics of abnormal chambers and valves
      • Ref: :
      • Bates, A Guide to Physical Exam ....279-284.
      • Review Dr. John McNulty's lesson, "Human cross sections". .
      • “ Nurses Informations”
      • http://nursesinformations.blogspot.com