The document describes the inspection of the precordium to identify the heart's apex, detect potential chamber enlargements, and assess for abnormal findings. Normal findings include a symmetrical precordium and recognizable apical impulse, while abnormalities may indicate conditions such as RV hypertrophy or aortic aneurysm. It also references essential anatomical and pathological knowledge related to heart chamber enlargement.

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

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 .

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.

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

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)

6. Knowledge Base Anatomy of heart chambers and its relationship to precardium Apical impulse

7. Knowledge Base Pathology of chamber enlargement Dilated cardiomyopathy ( Whole heart , section )

8. Knowledge Base Pathology of chamber enlargement RV hypertrophy ( Whole heart , section )

9. Knowledge Base Pathology of chamber enlargement Biventricular hypertrophy ( Whole heart , section )

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