Palpation of the precordium and abnormal apex beats
THE CONTEXT
Precordial palpation assesses the position and character of the apex beat, parasternal movement, palpable heart sounds and thrills.
Examination technique
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Place the fingertips over the apex to assess its position and character. The normal position is the fifth or sixth intercostal space at the mid-clavicular line.
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Place the heel of the hand over the left sternal border to assess for a parasternal heave or lift.
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Assess for thrills in all areas, including the aortic and pulmonary areas.
Character of the apex beat
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Volume overload, such as mitral or aortic regurgitation, produces a displaced, thrusting apex beat.
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Pressure overload, such as aortic stenosis or hypertension, produces a discrete, heaving apex beat.
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A dyskinetic apex beat, such as with a left ventricular aneurysm, is displaced and incoordinate.
Other palpable abnormalities
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A palpable first heart sound (S1) produces the tapping apex beat associated with mitral stenosis.
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A palpable P2 is associated with severe pulmonary hypertension.
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A left parasternal heave or lift, felt with the heel of the hand, is associated with right ventricular hypertrophy.
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A palpable thrill is associated with aortic stenosis.