Remodelling of the heart

Changes in size, shape, structure and physiology of the heart. This can happen as a result of exercise (physiological remodelling) or after injury (MI) to the heart muscle (pathological remodelling)

Palpation of the heart

1.Apex beat

2.Right ventricular lift

3.Pathologic pulsations

4.Chest thrills

Sequence of palpation of the heart

1. Apex beat

2. Right ventricular lift

3. Epigastric pulsation

4. Aorta

5. Pulmonary trunk

6. Jugular fossa

Apex beat

Contraction of LV

Purposes:

1.Location ( 5th intercostal space, 1-1,5 cm to the right from left midclavicular line)

2.Area (1–2 cm2) 3.Amplitude 4.Force

Apex beat shift

Left shift:

On the left side (3-4 см)Dilation and hypertrophy of LVDilation of RV

Fluid or air in right pleural cavity

Apex beat shift

Right shift:

Lying on the right side (1-1,5 см)

Pleuro-pericardial commissures

Disapperas :Left-sided hydrothoraxHydropericardium

Negative: (constrictive pericarditis)

Features of apex beat

1. Area

Normal 1-2 см2

>2 см2 - increased (LVH, thin chest, wide intercostal spaces, mediastinal tumor)

<1 см2 - narrow (thick or edematous subcutaneous fat, narrow intercostal spaces, emphysema)

> 3 см2 LV dilation

Features of apex beat

2. Amplitude

•high (exercise, anxiety, thyrotoxicosis, fever)low

3. Force

Increased (LVH)Decreased

4. Resistance – high in LVH