Percussion and Palpation of the Heart – Advanced Assessment

00:01 So, having reviewed auscultation of different types of valvular disease, it's worth us taking a look at a little bit about percussion and palpation of the heart.

00:09 These are definitely smaller topics in terms of the cardiovascular exam.

00:14 First off palpation.

00:16 You can put your hand over the apex of the heart, and you may be able to appreciate the point of maximal impulse.

00:22 I can say that in a lot of patients, it's very difficult to find, particularly in someone who has COPD for whom there's hyperinflation and maybe a lot of distance between your hand and the left ventricular impulse.

00:34 But in most people, it will be just a little bit farther away, maybe a little bit lateral from the nipple.

00:39 If it's significantly displaced over to the anterior axillary line, or even in the midaxillary line that would suggest evidence of left ventricular hypertrophy, or potentially just left ventricular dilation.

00:53 Lastly, in terms of percussion, historically, people used to percuss the borders of the heart.

00:58 It's not something which is particularly useful nowadays.

01:00 The one time where percussion may be useful is for example, in folks with emphysema.

01:05 So as you may recall, with emphysema, the heart in the pericardium is attached to the diaphragm.

01:12 But in COPD, the diaphragm which normally would be a dome shape is pushed all the way down.

01:16 Did have all that increased dead space in the thorax.

01:19 So, if the diaphragm is pushed down, the pericardium, which would have been over here, is also pulled down towards the midline.

01:28 And as such, if you were to percuss over that area, you might find residents, which we'll talk more about in the pulmonary section, but you're not going to hear the dullness that you'd expect over somebody's left ventricle.

01:38 In fact, you may find their point of maximal impulse when someone with severe COPD all the way down here in the subxiphoid area, as opposed to over here in the anterior axillary line.

01:51 So that's all.

01:52 We'll really talk about with palpation and percussion of the heart.