Palpation of right ventricular lift

Contraction of RV

Location – IV rib or intercostal space to the left from the sternum

Normally palpated in young people with thin chest (mild pulsation)

↑ RV lift – RVH

Epigastric pulsation

Eccentric RV hypertrophy

Below xyphoid process

at deep inspiration

Pulse from abdominal aorta

at deep inspiration

Pathologic pulsation

II right intercostal space – ascending aortic aneurism

Jugular fossa – Aortic arch aneurism, high BP, aortic insufficiency

Epigastric region– RVH, abdominal aortic aneurism

Liver pulse – Tricuspid valve insufficiency

Palpation of main arteries

a.Detection of systolic thrill and pulsation at the base of the heart

b.II right intercostal space- ascending aorta

c.II left intercostal space – pulmonary trunk

d.Jugular fossa – aortic arch

Pathologic pulsations

In LV aneurism pulsation is located to the left from NB sternum

In RVH pulsation is located to the left from sternum and in epigastic region

Heart thrill (purring thrill)

Diastolic

Mitral stenosis

Due to turbulent blood flow from left atrium to left ventricle

Does not fit on with apex beat and carotid pulse

Is determined at the apex

Heart thrill (purring thrill)

SystolicDue to aortic stenosis

Fits in with apex beat and carotid pulse

Is determined at the base of the heart

Percussion of the heart

Aims :

1.Detection of atrial and ventricular dilation 2.Detection of vessel bundle dilation

Rules of percussion

1.Standing position;

2.Comfortable conditions;

3.Finger is parallel to detecting border;

4.Direction of percussion: from lung sound to dull sound, from dull to absolutely dull;

5.The border is detected along the margin of the finger turned to lung sound

Borders of relative dullness

Lateral parts of the heart covered with the lungs. Reflects true size of the heart