Examination of the Heart Session Outline

SCREENING EXAM

Step 35: Inspect precordium, for parasternal and apical impulse

Step 36: Palpate precordium for parasternal and apical impulse or thrills

Step 37: Palpate suprasternal notch for abnormal pulsations or thrills

If you need to put your stethoscope on the patient to detect a cardiovascular abnormality you missed the boat. Most gallops or valvular heart murmurs have abnormalities of the arterial or venous pressure and/or abnormalities of the precordial inspection/palpation.  LOOK, FEEL, THEN LISTEN! You should note the position of the point of maximal impulse in the patient supine, however the quality and character of the PM is best appreciated in the left lateral decubitus positon.

Your stethoscope with the bell resting over the PMI, or a pencil held over the PMI can produce a visable representation of the palpable PMI.

Different parts of the hand serve a different purpose. Below is what has been found to be useful (suggested reading: Jonathan Abram's Essentials of Cardiac Physical Diagnosis, Lea & Febiger, Chapter 5, 55-78, 1987).

Step 39: Auscultate heart in five locations.

This is extremely well done in Bates and is a lot of information to digest. I have nothing to add!  See Bates, pgs 30--315.