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The sternum is a narrow, flat bone, forming the middle portion of the front of the chest. The top of the sternum supports the clavicles (collarbones) and its edges join with the costal cartilages of the first two pairs of ribs. The inner surface of the sternum is also the attachment of the sternopericardial ligaments. [2]
Vertical lines: Midline, lateral sternal line, parasternal line and midclavicular line. Horizontal lines: Level of the sternal angle, and zipho-sternal line. Anatomical "lines", or "reference lines," are theoretical lines drawn through anatomical structures and are used to describe anatomical location.
It is best heard at the left upper sternal border. This is the result of an increased volume going through the pulmonary valve. It has association with a fixed, split S2 and a right ventricular heave. Ventricular septal defect (VSD) will present as a holosystolic murmur. One can hear it at the left lower sternal border.
The right border of the heart (right margin of heart) is a long border on the surface of the heart, and is formed by the right atrium.. The atrial portion is rounded and almost vertical; it is situated behind the third, fourth, and fifth right costal cartilages about 1.25 cm. from the margin of the sternum.
The murmur is low intensity, high-pitched, best heard over the left sternal border or over the right second intercostal space, especially if the patient leans forward and holds breath in full expiration. The radiation is typically toward the apex. The configuration is usually decrescendo and has a blowing character.
Since the L ventricle has a higher pressure than the R ventricle, flow during systole occurs from the L to R ventricle, producing the holosystolic murmur. It can be best heard over the left third and fourth intercostal spaces and along the sternal border. It is associated with normal pulmonary artery pressure and thus S2 is normal.
The sternal angle (also known as the angle of Lewis, [1] angle of Louis, [2]: 297 angle of Ludovic, or manubriosternal junction [citation needed]) is the projecting [2]: 297 angle formed between the manubrium and body of a sternum at their junction at the manubriosternal joint.
The suprasternal notch is a visible dip in between the neck, between the clavicles, and above the manubrium of the sternum. It is at the level of the T2 and T3 vertebrae. [2] The trachea lies just behind it, rising about 5 cm above it in adults. [3]