The
CARDIOVASCULAR
SYSTEM
STATION 3
Inspection, Palpation & Percussion of the Praecordium
INSTRUCTIONS
There are 9 slides in this loop.
Work through the slides and practice the examination on
the SP.
Listen to the recordings on slide 9.
Please only move to the next station after the bell has rung.
INSPECTION
• SHAPE
pectus excavatum
pectus carinatum
barrel-shaped
INSPECTION cont.
• SCARS
Median sternotomy
coronary artery bypass surgery
valve surgery
Thoracotomy
mitral valvotomy
PALPATION
• APEX BEAT
5th intercostal space
just medial to MCL; palpate with
fingertips
well localised  area of impulse <
size of R5 coin
Displaces inferolaterally in
ventricular enlargement or as a
result of chest deformity, pleural /
pulmonary disease
Apex beat
R5 coin
PALPATION
• APEX BEAT – the character
Pressure loaded: systolic overloaded / hyperdynamic
forceful & sustained impulse
Volume loaded: diastolic overloaded / hyperkinetic
unco-ordinated impulse
felt over larger area than usual
 L ventricular dysfunction
Double impulse: two impulses felt with each systole
 hyprtrophic cardiomyopathy
Tapping apex beat: palpable first heart sound
 mitral stenosis
PALPATION cont.
• PARARSTERNAL HEAVE
place heel of hand just lateral to
the left parasternal border
right ventricular enlargement &
severe left atrial enlargement

right ventricle pushed anteriorly &
heel of hand lifted off chest wall
with each systole
• THRILLS
Thrills may also be described as palpable murmurs and are as a result of
turbulent blood flow. Usually felt in the base and apex of the heart
PERCUSSION
•
A technique you should all be comfortable with by now, can be used to
define the cardiac borders.
AUSCULTATION
• Click on the following numbers below in sequence and listen to the
recordings about normal heart sounds.
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1
2
3
4
5
6
7
Introduction
Normal 1st & 2nd heart sounds
Production & components of 1st sound
Normally split 1st sound
Production & components of 2nd sound
Fourth heart sound
Third heart sound