The apical impulse. Palpation of the heart area

What is a heart beat? Medical professionals are familiar with this concept. Those who are not related to medical activities, this definition has little to say about. How to make palpation to find the location of the heart beat, as well as some of the nuances of this procedure will be of interest to everyone, while the information presented in this article will be useful to those who only want to learn medical basics.

Heart Shove

A heartbeat is the pulsation of the anterior chest wall, which coincides with the contractions of the heart. It can be seen when looking at the patient. Although in some cases the apical impulse can not be seen:

• With obesity;
• Narrow intercostal spaces;
• Developed musculature;
• Large mammary glands.

It is best seen in people with asthenic physique. To detect it, in addition to the examination, palpation of the atrial region and determine the location of the heart beat, evaluate its properties for more information.

Technique of palpation

The right arm is located in the projection of the proposed thrust, between 3 and 6 ribs in the region of the apex of the heart. Determine the pulsation of the entire palmar surface, and then localize it with the tip of the index finger. It must be installed perpendicular to the thorax. With the widespread pulsation, the most left and lower regions are determined. This point is the place of a heartbeat. By the way, choose a place where the protrusion of the thorax, the flesh of the terminal phalanx of the touching finger is determined, and not its lateral surfaces.

If it is difficult to feel the apical impulse of the heart due to the characteristics of the thorax, then palpation is carried out with the chest tilted forward, or the patient is placed on the left side. The heart muscle in these positions is tightly attached to the chest and pushes the edge of the left lung.

In the position on the left side, the heart beat falls lower and to the left 2 cm, so the place of the shock is taken to the intercostal space, where the contraction is defined, but 2 cm medially from the region of the shock. Palpation of the apical tremor on exhalation increases the chances of determining its location, because at the moment of diaphragm lifting, the heart, making a pendulum movement to the left and up, moves to a more horizontal position, pushing the edge of the left lung.

Physicians determine certain properties of the heart beat:

• Location;
• Resistance;
• prevalence;
• height.

Location of heart beat

The contractions of the apex of the heart form a heartbeat. The apex lies slightly medial to the mid-clavicular line, in the 5th intercostal space on the left. It is relatively free and makes pendulum movements. If the position of the body changes, the shock is localized and localized. Some shake displacement options have been described above.

When the person turns to the right side of the pronounced displacement of the region of atrial pulsation does not occur, and the left lung, at this time, moving to the heart, can completely push it away from the chest wall. Therefore, in norm, on the right side, atrial pulsation can almost disappear.

Pathological displacement of heart pulsation

The displacement of the pulsation is divided into two types:

1. Displacement not associated with cardiac pathology (pneumothorax, hydrothorax, wrinkling of the lung, emphysema, altered level of diaphragm standing - ascites, pregnancy, flatulence, emaciation)
2. Pathological pulsation associated with cardiac pathology.

In the latter case, the displacement occurs to the left due to an increase in the left ventricle, sometimes to the anterior axillary line, and down to 6.7.8 intercostal spaces. Expansion of the right ventricle also gives a displacement of the border of the heart to the left, but the push remains in the 5 intercostal space.

Prevalence of cardiac ripple

The area of protrusion of the heart beat is about 2 cm². If it turns out to be larger, then talk about a diffuse or widespread jerk. With a smaller area, it is limited.

A widespread pulsation occurs if the heart is larger than its surface to the chest wall. This is observed:

• With a deep breath;
• Pregnancy;
• With mediastinal tumors, etc.

In the absence of these conditions, a spurt can be the result of the expansion of the heart (of all or any of its divisions).

A limited heart beat occurs when the heart of the smaller area is attached to the chest. The reason for this can be:

• Emphysema of the lungs;
• Low diaphragm standing;
• Exudative pericarditis ;
• Hydro-, pneumopericardium.

Height of a heartbeat

The height of the heart beat is the amplitude of the pulsating region of the chest. There are high, low and normal heart beat. The causes of low are the same as for limited ones. Accordingly, the spilled causes form a high apical impulse. It also occurs with tachycardia, due to thyrotoxicosis, fever, in smokers, under severe stress.

Resistant cardiac shock is pulsation, which gives a feeling of thick, dense muscle during palpation, not easily pressureable by hand. So, in case it is still diffuse, a strong character, it is defined as a dome-shaped apical impulse. Normally, it is not determined, but is formed with aortic defects or hypertension, when left ventricular hypertrophy develops .

Negative heart beat

Retraction of the chest wall in the region of the heart beat during systole is a negative apical impulse. It appears with a pronounced expansion of the right ventricle, which pushes back the apex of the left ventricle. Systolic reduction of it can form a similar phenomenon.

Retraction of intercostal spaces occurs with adhesive pericarditis.

Other pulsations

Diagnostically significant pulsations are pulsations of the aorta, pulmonary artery and epigastric pulsation. The first of them is invisible in the norm. Pathological pulsation appears in the II intercostal space on the right side of the sternum margin. The reasons for its occurrence include:

• Wrinkling of the right lung;
• Enlargement of the aorta (syphilis, aneurysm of the ascending aorta, aortic valve defects).

Pulsation of the pulmonary artery (II intercostal space to the left of the sternum) is the result of pulmonary hypertension with mitral valve defects.

Epigastric pulsation is found in the pit of the stomach. The reasons for its appearance:

• Omission of the right ventricle;
• Aneurysm of the abdominal aorta.

Conclusion

The above-described methods of investigation are important for the practical doctor, however, in connection with the development of hardware diagnostics, the doctors' commitment to the determination of pathology by examination and palpation for the last decades has significantly decreased.

At the same time, the need to continue the above-described practice is very high. Specialists who determine the apical impulse by palpation should be encouraged and disseminated more actively information on the application of this method in medicine.

In many cases, the use of palpation led to positive results, including early diagnosis of the disease. The apical impulse determined by a specialist (in norm and in various pathologies) is a serious indicator for establishing methods of treating patients.