Palpation. Usually inspection and palpation are discussed together because there is an intimate relationship between these two processes in the heart examination. Palpation not only confirms the results in inspection, but also discovers diagnostic signs.
Usually inspection and palpation are discussed together because there is an intimate relationship between these two processes in the heart examination. Palpation not only confirms the results in inspection, but also discovers diagnostic signs.
systole with great amplitude more
than 2cm diameter
Decrease amplitude: myocarditis
Massive pericardial effusion: impulse cannot be palpable
Thrill are palpable murmurs some what similar to the sensation on the throat a purring cat. Thrills are actually palpable fine vibrations, most commonly produced by blood from one chamber of the heart to another through a restricted or narrowed orifice, it may occur in systole, diastole, presystole and at times may be continuous.
according blood velocity
Intensity degree of narrowing
to gradient between
rapid fine thrill
slow coarser thrill
The diastolic thrill felt near the apex is pathognomic of mitral stenosis(二狭). It may be compared quit accurately to the vibration which accompanies the sound of satisfaction which a cat makes.
A systolic thrill may be felt over the precordium with its maximum intensity at the aortic area in aortic stenosis(主狭). This thrill is usually rough and purring, and commonly of greater intensity than any other thrill felt over the heart.
In pulmonary stenosis(肺动脉瓣狭窄) a rough systolic thrill is felt over the pulmonary area and from here is transmitted upward and diagonally toward the left clavicle.
In aneurysm of the ascending aorta(升主动脉瘤), which produces a definite area of pulsation, a systolic thrill may be felt over this area.
systole second right ICS AS
second left ICS PS
third fourth left ICS VSD
diastole apical area MS
continuous 2nd left ICS PDA
Pericardial friction rub(心包摩擦感) is a to-and-fro grating sensation, which is usually present during both phases of cardiac cycle, often rubs are more readily palpated with the patient sitting erect and leaning forward during the end period of deep inspiration.