Inspection and Palpation of the Heart
- The Aortic Area: observe for any pulsation, thrill, the vibration of the aortic valve closure.
- Pulsation of aortic aneurysm
- thrill of aortic stenosis
- accentuated aortic valve closure
- sounds of hypertension
- The Pulmonary Area: observe for any pulsation, thrill, vibration of pulmonary valve closure
- Pulsation of increased pressure or flow in the pulmonary artery
- thrill of pulmonic stenosis
- accentuated pulmonic valve closure sound of pulmonary hypertension
- The Right Ventricular Area: observe for a diffuse lift or heavy thrills
- In thin patients, or those with anemia, anxiety, hyperthyroidism, fever or pregnancy (where cardiac output is increased) a brief right ventricular impulse is frequently felt here and does not necessarily indicate heart disease.
- Sustained systolic lift of right ventricular hypertrophy
- thrill of ventricular septal defect
- The Apical or Left Ventricular Area:
- with the palm of your hand try to locate the apical impulse
- if you cannot find it, ask the patient o roll on his left side, this maneuver helps you find and assess the qualities of the apical impulse.
- When palpable, make finer observations
- The Epigastric Area
- note any pulsations
- abdominal aorta pulsations may be felt here
- distinguish aorta from right ventricular pulsations by placing palm of hand on epigastric area and slide fingers up under the rib cage.
- The aorta pulses forward against the palmar surface of your fingers
- The right ventricle beats downward against your fingers
- Increased aortic pulse in aneurysm of the abdominal aorta
- Increased pulsing in aneurysm of the abdominal aorta
- Increased pulsing in aortic regurgitation
- Right ventricular pulsation in right ventriclar hypertrophy.
Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.