Pulses & Precordium

Pulses & Precordium

Palpation Palpation Feel for diagnosis Continuing Medical Implementation ...bridging the care gap Palpation Palpation By the time you put stethoscope to chest you should know what you are going to hear If you dont hear what you expect,explain it Continuing Medical Implementation

...bridging the care gap Palpation-Pulses Palpation-Pulses Rhythm, rate, regularity Contour Water hammer pulse-AR Brachial-radial delay AS Pulsus paradoxus

Tamponade COPD Pulsus alternans LV dysfunction Continuing Medical Implementation ...bridging the care gap Carotid Carotid Examination Examination Carotid upstroke brisk, normal or delayed bisferiens or anacrotic volume: normal, increased or decreased

Carotid auscultation Bruit Transmitted murmur A2 audible in neck? Presence excludes severe AS Continuing Medical Implementation ...bridging the care gap Palpation Palpation -- Precordium Precordium Parasternal: Palpable P2-pulmonary HTN Thrill

VSD/HCM RV lift RVH Severe MR Continuing Medical Implementation ...bridging the care gap Precordium-Palpation Precordium-Palpation Parasternal Lift: RVE or severe MR Thrill: VSD, HOCM (IHSS) Palpable P2 (ULSB): pulmonary hypertension

Medial retraction LVE Lateral retraction RVE Continuing Medical Implementation ...bridging the care gap Palpation Palpation -- Apex Apex Apex: Palpable in 1 of 5 adults age 40 Best felt with fingertips or finger pads Normal Location: No more than 10 cm from mid-sternal line in the supine position Left decubitus position not reliable for apical location

Normal Size: No larger than 3 cm (about 2 finger breadths) Continuing Medical Implementation ...bridging the care gap Apex-Dynamic Apex-Dynamic Qualities Qualities LV impulse outward movement like a ping pong ball were protruding between the ribs Apex moves outward for the first third of systole and falls away rapidly Lasts for no more than 2/3 of systole Continuing Medical Implementation

...bridging the care gap ApexDynamic ApexDynamic Abnormalities Abnormalities Sustained Apex: correlates with pressure overload ( > 2/3 systole-hangs out to S2) AS, LVH or LV systolic dysfunction Hyperdynamic Apex: correlates with volume overload AR/MR palpable S4 (atrial kick) palpable S1 (MS) palpable non-ejection click (MVP) Continuing Medical Implementation

...bridging the care gap ApexDynamic ApexDynamic Abnormalities Abnormalities Atrial kick: Palpable S4 Loss of LV compliance LVH 2o Hypertension Aortic Stenosis

Hypertrophic Cardiomyopathy Continuing Medical Implementation ...bridging the care gap Non-invasive Non-invasive ejection ejection fraction fraction Palpable S4/ apex not sustained EF > 50% Palpable S4/ Apex sustained EF 40-50% S4 not palpable/ Apex sustained

EF < 40% TITLE: The apical impulse in coronary heart disease. AUTHORS: Ranganathan N; Juma Z; Sivaciyan V http://130.14.32.45/cgi-bin/VERSION_B/IGM-client?1 2653+records+81 SOURCE: Clin Cardiol 1985 Jan;8(1):20-33 Continuing Medical Implementation ...bridging the care gap

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