PALPATATION

1. APEX BEAT:

• Patient should be examined in the supine, sitting, and left lateral decubitus position.

• Normal apex beat is palpable as brief outward impulse

(intersection of left mid clavicular line and 5th ICS)

• Apex beat > 2cm indicate LV enlargement.

• Double apical impulse caused by LVH and forceful LA contraction.

2. LEFT PARASTERNAL LIFT

• Best appreciated by the distal palm or with the finger tip.

• Palpable anterior systolic movement sustained up to S2

indicate RVH.

• Giant presystolic lift seen in HCM.

3. ABDOMEN

• Abdominal aorta (aneurysm)

• Liver (hepatomegaly, pulsatile liver)

• Ascitis

4. Diastolic shock

• Palpable S2

5. Thrill

• Palpable murmur

• Definite evidence of presence of organic ht ds.