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The character of the apex beat may provide vital diagnostic clues: A forceful impulse indicates volume overload in the heart (as might occur in aortic regurgitation) An uncoordinated apex beat involving a larger area than normal indicates ventricular dysfunction; such as an aneurysm following myocardial infarction
Left ventricular function can be assessed by determining the apical impulse. A normal or hyperdynamic apical impulse suggests good ejection fraction and primary MR. A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe MR. This type of murmur is known as the Castex Murmur. Holosystolic (pansystolic)
The apex beat is assessed for size, amplitude, location, impulse and duration. There are specific terms to describe the sensation such as tapping, heaving and thrusting. Often the apex beat is felt diffusely over a large area, in this case the most inferior and lateral position it can be felt in should be described as well as the location of ...
This impulse may also be felt in dilated right ventricular myopathy. The palpation of dilated myopathy differs in that the impulse tends to be vigorous and brief. This is in contrast with the sustained impulse of the hypertrophied right ventricle. [5] A parasternal heave may also be felt in mitral stenosis. [6]
Other possible exam findings are bounding carotid and peripheral pulses. These are also known as Corrigan's pulse or Watson's water hammer pulse. Another possible finding is a widened pulse pressure. Mitral stenosis presents as a diastolic low-pitched decrescendo murmur. It is best heard at the cardiac apex in the left lateral decubitus position.
Hyperdynamic apex Hyperdynamic precordium is a condition where the precordium (the area of the chest over the heart) moves too much (is hyper dynamic ) due to some pathology of the heart . That means a forceful and hyperdynamic impulse (large amplitude that terminates quickly) can be palpated during physical examination. [ 1 ]
The cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart (cardiac examination), lungs (pulmonary examination), belly (abdominal examination) and the blood vessels (peripheral vascular ...
Dyspnea and chest pain commonly occur during daily activities. Syncope may also occur. On physical examination, significant findings include: loud systolic murmur and palpable triple apical impulse due to a palpable presystolic fourth heart sound. Aortic dissection is characterized by severe chest pain that radiates the back.