The precordium describes the area of the chest wall located directly over the heart. Palpation is a physical examination method that involves using touch to assess the body’s structures. This technique allows healthcare professionals to feel for various characteristics of the heart’s activity through the chest wall.
Understanding the Purpose
Palpation of the precordium provides insights into cardiac function and potential underlying conditions. It helps assess heart activity and detect unusual pulsations or movements.
The examination can reveal thrills (vibratory sensations) or lifts and heaves (sustained outward movements of the chest wall). These findings provide diagnostic clues that guide further assessment and contribute to a comprehensive cardiac evaluation.
Preparing for Examination
Before beginning precordial palpation, careful preparation ensures an accurate and comfortable assessment. The patient should be positioned comfortably, typically lying flat on their back. For a more detailed examination of the apical impulse, the patient may be asked to roll slightly onto their left side.
The examiner should stand or sit to the patient’s right side, allowing easy access to the precordium. Ensuring the room and examiner’s hands are warm helps prevent patient discomfort and muscle tension, which could obscure findings. Adequate lighting is also important to observe any subtle chest movements before palpation begins.
The Palpation Technique
Precordial palpation involves a systematic approach, utilizing different parts of the hand to detect various cardiac phenomena. The examination begins with a general survey using the entire palm or the ball of the hand to broadly assess for widespread pulsations or movements across the precordium. This initial sweep helps identify areas requiring more focused attention.
The examiner then proceeds to specific areas, starting with the apex of the heart, usually located in the fifth intercostal space just inside the midclavicular line. Here, the pads of the fingers are used to feel for the apical impulse, also known as the point of maximal impulse (PMI), which is the pulsation created by the heart’s apex hitting the chest wall during systole.
Moving superiorly, the examiner palpates along the left sternal border, using the ball of the hand to search for lifts or heaves, which are sustained outward thrusts of the chest wall. These can indicate increased ventricular activity or chamber enlargement. Palpation also extends to the right sternal border and the base of the heart, including the second intercostal spaces on both sides of the sternum, to assess for pulsations from the aorta or pulmonary artery and to detect thrills.
The pads of the fingers are particularly effective for detecting these subtle vibrations. Exploration of each area, including the epigastric region below the xiphoid process, helps ensure no significant findings are overlooked.
Recognizing Normal and Abnormal Findings
During precordial palpation, a normal finding typically involves a discrete, localized apical impulse. This impulse is usually felt as a brief, gentle tap in the fifth intercostal space, just medial to the midclavicular line, and its diameter generally does not exceed 2.5 centimeters. It represents the normal contraction of the left ventricle.
Abnormal findings can include several distinct sensations. Thrills are palpable vibrations, feeling like a purring sensation, often indicating turbulent blood flow. Heaves or lifts are sustained, outward thrusts of the chest wall, which suggest an increased workload or enlargement of the underlying ventricle.
The apical impulse itself can also present abnormally. A displaced apical impulse, felt further to the left or inferiorly than its usual location, can suggest an enlarged heart. An abnormally strong or sustained apical impulse, feeling more forceful or lasting longer than a brief tap, may also indicate increased ventricular work or hypertrophy. These deviations from normal provide indicators for further medical evaluation.
References
Assessment of the Cardiovascular System – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557723/. [Accessed 2024-08-03].