Abnormal Finding
- Bulge: Note the site of bulge.
- Precordial bulge: RV hypertrophy, LA enlargement, LV aneurysm
- Aortic area bulge: Aortic aneurysm, Dilation (e.g., post stenotic dilation)
- Thrust: Note the site, size, amplitude , duration, upstroke and downstroke characteristics.
- Parasternal area :
- Marked increase in amplitude with little change in duration; Volume overload of RV (ASD)
- Marked increase in amplitude and duration; Pressure overload of RV (Pulmonic stenosis, Pulmonary hypertension)
- Aortic area: (Aortic aneurysm)
- Pulmonic area: Prominent pulsation (Pulmonary artery dilatation, Increased flow , Pulmonary hypertension)
- Apical impulse
- Sustained lift : Pressure overload, LV hypertrophy (Aortic stenosis)
- Hyperdynamic: Marked increase in amplitude Volume overload (Mitral insufficiency, Aortic insufficiency)
- Undetectable apical impulse: (Obesity, Emphysema, Muscular chest, Pericardial effusion)
- Hypokinetic apical impulse and displaced to left:(Dilated failing Heart)
- Thrill: It is a purring sensation. Note its location and timing.
- Parasternal area: (PDA, ASD, VSD)
- Aortic area: ( Aortic stenosis)
- Pulmonic area: ( Pulmonary stenosis)
- Apical area: ( Mitral insufficiency, Mitral stenosis)
- Tap: Loud sounds evoke a palpable feeling like a tap.
- Aortic area: Palpable A2 ( Hypertension)
- Pulmonic area: Palpable P2 ( Pulmonary hypertension)
- Rub: Scratchy feeling.
- Szorsy Gallops: Can be palpable