13.examination of a patients with cardiac disease— inspection, palpation, percussion
Covers the physical examination of the heart by inspection, palpation and percussion. Inspection looks at the precordium and peripheral signs such as cyanosis, clubbing, oedema and jugular venous distension, with the likely cause of each noted. Palpation covers the apex beat, thrills over each valve area and heaves or lifts. The final part explains how to percuss the right, upper and left borders of the heart, with illustrations throughout.
Topic 12 of 30 in the MU Sofia syllabus for Internal Medicine (Practical) (Medicine, Year 3). The free AceMed note covers it in 4 sections, about 337 words (3 min of reading), with 14 flashcards.
In this note
Physical methods of examination of a patients with cardiac disease—inspection, palpation, percussion
A. Inspection
B. Palpation
C. Percussion
A. Inspection
1. Precordium:
Bulges: Could indicate aneurysms, enlarged heart, or pericardial effusions.
Visible Apex Beat: Suggests displacement due to heart failure, hypertrophy, or cardiomyopathy.
Scars: Typically from heart surgeries like valve replacement, bypass, or pacemaker insertion.
2. Peripheral Signs:
Cyanosis:
Central Cyanosis: Observed in the lips/tongue, typically due to left-sided heart failure (poor oxygenation).
Peripheral Cyanosis: Seen in fingers/toes, may be linked to right-sided heart failure (poor circulation).
Clubbing: Seen in chronic cyanosis, often seen in congenital heart disease or chronic lung conditions.
Edema:
Leg Edema: Indicates right-sided heart failure or venous insufficiency.
Ascites: Suggests portal hypertension (common in right heart failure).
Jugular Venous Distention (JVD):
Reflects increased central venous pressure.
Common in right-sided heart failure, tricuspid regurgitation, and pericardial tamponade.
B. Palpation
3. Apex Beat:
Location: 5th intercostal space, midclavicular line (MCL).
Character:
Tapping: Normal.
Heaving: Suggests left ventricular hypertrophy (LVH).
Displaced: Can be seen in heart failure or dilated cardiomyopathy (displaced laterally).
4. Thrills:
Feel for vibrations over valve areas:
Aortic Valve: Right 2nd intercostal space, right sternal border.
Pulmonic Valve: Left 2nd intercostal space, left sternal border.
Tricuspid Valve: Left 4th or 5th intercostal space, lower sternal border.
