Palpation of Precordium

• Palpate the apical impulse by localizing with finger pad
• Ball of the hand will be more sensitive to thrills and/or vibrations and the fingertips more sensitive to pulsations
• Thrills are vibrations that are often described as having the quality of a cat purring
• Have the person exhale and then hold
• Have the patient roll onto their left side to palpate the impulse

Abnormal Apical Impulses

• If felt over 2 ICS’s, increased in amplitude or laterally or inferiorly displaced may be reflection of increased volume load and left ventricular dilatation such as can be the case in mitral insufficiency or left ventricular failure
• If impulse is sustained, enlarged and laterally displaced it may be suggestive of obstruction to the outflow with increased ventricular load and concentric hypertrophy of the muscle such as in aortic stenosis or systemic hypertension
• Pulsation over the right ventricular area is suggestive of right ventricular enlargement
• Palpate the epigastrium by placing the palmar surface of the hand over the area and sliding the fingers toward the xiphoid
• Pulsations here that push down on the fingertips can indicate right ventricular movement and therefore enlargement
• Pulsations pushing the hand upward may originate in the aorta and could reflect a aortic aneurysm or aortic regurgitation
• Palpate anterior chest wall for thrills:
  • 2nd ICS RSB
  • 3rd ICS LSB
  • 5th ICS MCL