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

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

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