Palpation

Preparation of palpation :-

• 1.Lay the whole hand flat on the chest to get a general impression of the cardiac activity.
• 2. Now localise the apex beat and assess its character 
• 3. if necessary , ask the patients to roll on to the left side .

Palpation points: 

1. Apex beat : it is the most inferior and lateral point of definite cardiac pulsation .

• a. position:- Left 4th or 5th intercostal spaces just medial to medclavicular line .
• b. Character of apex beat :- 
• -Normal 
• -Heaving (forceful & sustained) - example-LVH
• -Tapping (sudden hit ) EXAMPLE- MS
• - Diffuse 
• -Double apical impulse 
• - thrusting -example -MR 

2. Thrill :- a palpale murmur is called thrill .( feeling is like purring of cat )

• a. site of thrill
• b.Timing -
• systolic-- VSD,Pulmonary stenosis,aortic stenosis
• diastolic--Mitral stenosis,Tricuspid stenosis
• 
  
• c.Radiation 
• d.Relation with respiration .

3. Left parasternal heave :- ( feel by ulnar border of hand) -example: Right ventricular hypertrophy(RVH)

4. Palpable heart sound