1 / 11

Palpation

Palpation. Feel for diagnosis. Palpation. By the time you put stethoscope to chest you should know what you are going to hear If you don’t hear what you expect,explain it. Palpation-Pulses. Rhythm, rate, regularity Contour Water hammer pulse-AR Brachial-radial delay AS Pulsus paradoxus

sissy
Download Presentation

Palpation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Palpation Feel for diagnosis

  2. Palpation • By the time you put stethoscope to chest you should know what you are going to hear • If you don’t hear what you expect,explain it

  3. Palpation-Pulses • Rhythm, rate, regularity • Contour • Water hammer pulse-AR • Brachial-radial delay AS • Pulsus paradoxus • Tamponade • COPD • Pulsus alternans • LV dysfunction

  4. Carotid 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

  5. Palpation - Precordium Parasternal: • Palpable P2-pulmonary HTN • Thrill • VSD/HCM • RV lift • RVH • Severe MR

  6. Precordium-Palpation Parasternal • Lift: RVE or severe MR • Thrill: VSD, HOCM (IHSS) • Palpable P2 (ULSB): pulmonary hypertension • Medial retraction LVE • Lateral retraction RVE

  7. Palpation - 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)

  8. Apex-Dynamic 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

  9. Apex–Dynamic 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)

  10. Apex–Dynamic Abnormalities Atrial kick: • Palpable S4 • Loss of LV compliance • LVH 2o Hypertension • Aortic Stenosis • Hypertrophic Cardiomyopathy

  11. Palpable S4/ apex not sustained EF > 50% Palpable S4/ Apex sustained EF 40-50% S4 not palpable/ Apex sustained EF < 40% Non-invasive ejection fraction TITLE: The apical impulse in coronary heart disease. AUTHORS: Ranganathan N; Juma Z; Sivaciyan V SOURCE: Clin Cardiol 1985 Jan;8(1):20-33 http://130.14.32.45/cgi-bin/VERSION_B/IGM-client?12653+records+81

More Related