Palpating The Heart

The normal apex beat lies in the 5th left intercostal space (the space below the 5th rib) within the midclavicular line which, in the male, is the intercostal space immediately below and approximately in line with the left nipple, The intercostal space can be located by counting down from the second rib which is at the level of the sternal angle. The normal apical impulse gently and briefly lifts the palpating lingers and is quite localised. I lowever, in some normal subjects, particularly if overweight or muscular, the apex beat may be impalpable. The apex beat may also be impalpable in patients with asthma or emphysema because the chest is hyperinflated.

Examination sequence

□ Inspect the precordium with the patient sitting at 45° to the upright with the shoulders horizontal, looking for any surgical scars, pulsations or other abnormalities.

□ Lay the whole hand Hat on the chest to gel a general impression of cardiac activity (Fig. 3.24A).

□ Localise the apex beat (Fig. 3.24B): if necessary ask the patient to roll on to the left side (Fig. 3.24C).

□ Assess the character of the apex beat,

□ Count the rib spaces from the sternal angle.

□ Palpate for the right ventricle using the heel of the hand

KEY POINTS

• General examination may reveal features of disorders which can cause, or aggravate, cardiac symptoms, e.g. anaemia, hyperthyroidism.

• Atrial fibrillation produces a pulse which is irregular in both time and volume.

• Pulse character should be assessed from a large artery, e.g. the carotid.

• Use the thumb to palpate brachial and carotid pulses; never palpate both carotids simultaneously.

• Accurate measurement of arterial blood pressure requires care and attention to detail.

• Pulsatile elevation of the JVP is a valuable sign of elevated right atrial pressure,

• A transient rise in the jugular venous pressure during abdominal compression is normal.

Surface Marking Heart
Fig. 3.23 Surface markings of the valves in relationship to the radiological outline of the heart. The directions in which murmurs are preferentially conducted from the valves depend upon the direction of Ihe blood flow producing the murmur.

Aorla

Superior vena cava

Aortic valve

Tricuspid valve

Pulmonary artery

Pulmonary valve

Left atrial appendage

Mitral valve 5th rib

Apex Beat Palpate
Fig. 3.24 Palpating the heart. H Use the hand to palpate the cardiac impulse. Œ3 Localise the apex beat with a finger. [2 If necessary, roll the patient into the left lateral position. 0? 1 Palpate Irom apex to sternum for parasternal pulsations.

firmly applied to the left parasternal position while the breath is held in expiration (Fig. 3.24D). LJ Palpate for thrills at the apex and to both sides of the sternum,

□ Where a murmur is audible, palpate again for a thrill using the flat of the lingers while the patient is in the optimum position (see below).

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Responses

  • uwe wagner
    Where to palpate apical impulse?
    8 years ago
  • orlando
    How to palpate for thrill?
    8 years ago
  • Arturo
    Where on the body to do apex beat?
    8 years ago
  • Reece Watson
    Where do you palpate the cardiac apex?
    8 years ago
  • Irene
    How do you palpate for the second intercostal space?
    8 years ago
  • aloisio
    Where to palpate parasternal impulse?
    8 years ago
  • merico baresi
    How to palpate precordium?
    7 years ago
  • findlay jones
    How to inspect apex beat?
    7 years ago
  • filomena
    Where on the chest to palpate the heart?
    7 years ago
  • theobald
    How to palpate apex beat?
    7 years ago
  • maja
    Where is the apex beat measured?
    7 years ago
  • awet
    What to expect from a cardiovascular examination?
    6 years ago
  • MICHAEL
    How to palpate cardiac thrill?
    4 years ago
  • Nina
    Where to place hand during apical pulse measurement?
    4 years ago
  • Darcie Shaw
    HOW TO PALPATE THE HEART YOUTUBE?
    3 years ago
  • sagramor goodchild
    How to localise apex beat?
    3 years ago
  • poppy
    How to palpate cardiac impulse?
    2 years ago
  • Ulrich
    Why beath is held during palpation of base of heart?
    2 years ago
  • quinn
    What is the step for apex beat?
    2 years ago

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