Precardium: Inspection

Method Of Exam

Inspect the precordium tangentially while the patient is laying flat in bed from either the patient's head or foot for symmetry and pulsations.

Normal:

* The precordium is symmetrical.
* In thin individuals, the apical impulse is recognizable.
* Apical impulse is located in 5th interspace just internal to midclavicular line.
* The left precordium will dip slightly during systole.


Abnormal Finding

* Bulge
> Precordial: Implies onset during childhood ( RV hypertrophy.)
> Aortic area bulge:( Aortic aneurysm)

* Pulsations
> Precordial : RV hyperactivity
> Displaced apical impulse: (Cardiac hypertrophy or dilatation, Mediastinal shift, Deformities of thorax, Raised intra-abdominal pressure)
> Apical impulse on right: (Dextrocardia)
> Aortic:( Aneurysm or dilatation)
> Pulmonary: (Pulmonary artery dilatation)
> Epigastric: (RV hypertrophy)


Knowledge Base

Anatomy of heart chambers and its relationship to precardium

Apical impulse

Pathology of chamber enlargement

* Dilated cardiomyopathy (Whole heart, section)
* RV hypertrophy (Whole heart, section)
* Biventricular hypertrophy (Whole heart, section)