Examination of the heart

Examination of the heart

Cardiac hump

Visible apex beat

Visible epigastric pulsation (right ventricular hypertrophy)

Visible pulsation of main arteries

2nd right intercostal space (aneurism of ascending aorta and aortic arch)

2nd left intercostal space (dilation of pulmonary trunk in mitral stenosis)

3rd- 4th left intercostal space (heart aneurism)

Examination of the vessels

«Carotid danse», de Musset sign (aortic valve insufficiency)

Jugular veins distension (congestion in systemic circulation, high central venous pressure)

Venous pulse (tricuspid valve insufficiency)

Quincke`s sign (aortic valve insufficiency)

Palpation of the heart

Aims:

Detection of ventricular hypertrophyDetection of ventricular dilationDetection of vascular dilationDetection of aortic aneurisms

Myocardial hypertrophy

Thickening of ventricular walls as a compensation to volume- and pressure overload

Dilation

Distension of one or several chambers of the heart :

Compensation to overload (tonogenic)

Decompensation and decrease of myocardial contractility (myogenic)

Types of cardiomegaly

Concentric – without dilation

Eccentric – mild hypertrophy and severe dilation

Dilation without hypertrophy

Types of cardiac overload

Preload – volume overload

Postload – pressure overload

Increased postload

postload => compensatory hypertrophy without dilation. (concentric)

Aortic/pulmonary stenosis (LVH/RVH)

Arterial hypertension (LVH)

Pulmonary embolism (RVH)

Increased preload

preload => tonogenic (compensatory) dilation + ventricular hypertrophy (eccentric)

• Mitral valve insufficiency

(Eccentric left ventricular and left atrium hypertrophy)

Aortic valve insufficiency (eccentric LVH)

Pulmonic valve insufficiency (eccentric RVH)

Tricuspid valve insufficiency (Eccentric right ventricular and

right atrium hypertrophy)