cardiovascular disorders
Cardiovascular Examination
Chest Inspection and Palpation
Chest contour and any visible cardiac impulses are inspected. The precordium is palpated for pulsations (determining apical impulse and thus cardiac situs) and thrills. Chest deformities may occur in a number of disorders. (a prominent birdlike sternum) may be associated with Marfan Syndrome (which may be accompanied by aortic root or mitral valve disease) or (depressed sternum) with a narrow anteroposterior chest diameter and an abnormally straight thoracic spine may be associated with hereditary disorders involving congenital cardiac defects (eg, Turner Syndrome , The patient lays at approximately a 30 to 45 degree angle. Approaching the patient from the right side, the clinician systematically palpates the precordium. Theapical impulsein healthy individuals should be palpable between the 4th and 5th intercostal space just medial to the midclavicular line and cover an area < 2 to 3 cm in diameter. Acentral precordial heaveis a palpable lifting sensation under the sternum and anterior chest wall to the left of the sternum; it suggests severe right ventricular hypertrophy. Occasionally, in congenital disorders that cause severe RV hypertrophy, the precordium visibly bulges asymmetrically to the left of the sternum. Asustained thrust at the apex(easily differentiated from the less focal, somewhat diffuse precordial heave of RV hypertrophy) suggests LV hypertrophy. Abnormal focal systolic impulses in the precordium can sometimes be felt in patients with a dyskinetic ventricular aneurysm. An abnormal diffuse systolic impulse lifts the precordium in patients with severe mitral regurgitation. The lift occurs because the left atrium expands, causing anterior cardiac displacement. A diffuse and inferolaterally displaced apical impulse is found when the LV is dilated and hypertrophied (eg, in Mitral Regurgitation ). are a palpable buzzing sensation present with particularly loud murmurs. Their location suggests the cause (see table Location of Thrills and Associated Disorder ). A sharp impulse at the 2nd intercostal space to the left of the sternum may result from exaggerated pulmonic valve closure in Pulmonary Hypertension . A similar early systolic impulse at the cardiac apex may represent closure of a 