Inspection and Palpation of the Heart

 

  1. 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
  1. 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

 

  1. 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

 

  1. 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
  1. 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
  1. Increased aortic pulse in aneurysm of the abdominal aorta
  2. Increased pulsing in aneurysm of the abdominal aorta
  3. Increased pulsing in aortic regurgitation
  4. Right ventricular pulsation in right ventriclar hypertrophy.

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

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