What is a cardiac impulse? He alth professionals are familiar with this concept. For those who are not related to medical activities, this definition says little. How to palpate to find out 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 for those who just want to learn the basics of medicine.
Heart Thrust
Cardiac impulse is a pulsation of the area of the anterior chest wall, which coincides with the contractions of the heart. It can be seen when examining the patient. Although in some cases the apex beat may not be visible:
- for obesity;
- narrow intercostal spaces;
- developed muscles;
- large mammary glands.
It is best seen in people with asthenic physique. To detect it, in addition to examination, they palpate the precordial region and determine the location of the cardiac impulse, evaluate its properties for additional information.
Palpation technique
The right hand is placed in the projection of the expected push,between the 3rd and 6th rib at 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 chest. With widespread pulsation, its most left and lower region is determined. This point is the place of the heart impulse. By the way, they choose the place where the protrusion of the chest is determined by the pulp of the terminal phalanx of the probing finger, and not by its side surfaces.
If it is difficult to feel the apical beat of the heart due to the characteristics of the chest, then palpation is performed with the chest tilted forward, or the patient is placed on the left side. The heart muscle in these positions is tightly adjacent to the chest and pushes the edge of the left lung.
In the position on the left side, the cardiac impulse falls 2 cm lower and to the left, therefore, the intercostal space where the contraction is determined, but 2 cm medially from the region of the impulse, is taken as the place of the impulse. Palpation of the apex beat on expiration increases the chances of determining its location, because at the moment of the diaphragm lift, the heart, making a pendulum movement to the left and up, moves to a more horizontal position, pushing the edge of the left lung.
Doctors determine certain properties of the heart impulse:
- location;
- resistance;
- prevalence;
- height.
Location of heart beat
The contractions of the apex of the heart form a cardiac impulse. The top liesslightly medial to the mid-clavicular line, in the 5th intercostal space on the left. It is located relatively freely and makes pendulum movements. If the position of the body changes, the localization of the shock also shifts. Some of the push offset options have been described above.
When a person turns to the right side, there is no pronounced displacement of the atrial pulsation area, and the left lung, at this time, approaching the heart, can completely move it away from the chest wall. Therefore, normally, on the right side, the atrial pulsation may almost disappear.
Pathological displacement of the heart pulsation
Ripple offset is divided into two types:
- Displacement not related to cardiac pathology (pneumothorax, hydrothorax, lung shrinkage, pulmonary emphysema, altered level of diaphragm standing - ascites, pregnancy, flatulence, emaciation)
- 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. The expansion of the right ventricle also gives a displacement of the border of the heart to the left, however, the push remains in the 5th intercostal space.
Prevalence of cardiac pulsation
The area of protrusion of the cardiac impulse is about 2 cm². If it turns out to be larger, then they talk about a spilled or widespread shock. With a smaller area, it is limited.
A widespread pulsation occurs if the heart with its larger surface is adjacent tochest wall. This is observed:
- while taking a deep breath;
- pregnancy;
- for tumors of the mediastinum, etc.
In the absence of these conditions, a diffuse shock may be the result of an expansion of the heart (of all or any of its departments).
Limited cardiac impulse occurs when the heart has a smaller area adjacent to the chest. The reason for this may be:
- emphysema;
- low aperture setting;
- exudative pericarditis;
- hydro-, pneumopericardium.
Heart rate
The height of the heart beat - the amplitude of the pulsating area of the chest. Distinguish high, low and normal cardiac impulse. The reasons for low are the same as for limited. Accordingly, the causes of the spilled form a high apex beat. It also occurs with tachycardia, due to thyrotoxicosis, fever, in smokers, with strong exertion.
Resistant cardiac impulse - a pulsation that gives the feeling of a thick, dense muscle on palpation, not easily yielding to pressure with a hand. So, if it also has a spilled, strong character, then 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
The retraction of the chest wall in the region of the cardiac impulse during systole isnegative apical impulse. It appears with a pronounced expansion of the right ventricle, which pushes back the top of the left ventricle. His systolic contraction may form a similar phenomenon.
Retraction of the intercostal spaces occurs with adhesive pericarditis.
Other ripples
Diagnostically significant pulsations are the pulsation 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 at the edge of the sternum. The reasons for its occurrence include:
- shrinkage of the right lung;
- aortic dilation (syphilis, ascending aortic aneurysm, aortic valve disease).
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 epigastric fossa. Reasons for its appearance:
- omission of the right ventricle;
- abdominal aortic aneurysm.
Conclusion
The above research methods are important for a practical doctor, however, due to the development of hardware diagnostics, doctors' commitment to determining pathology by examination and palpation has significantly decreased over the past decades.
At the same time, the need to continue the above practice is very great. Those who determine the apex beat by palpation should be encouraged and more actively disseminated information about the use of this method inmedicine.
In many cases, the use of palpation led to positive results, including early diagnosis of the disease. The apex beat determined by a specialist (in normal conditions and in various pathologies) is a serious indicator for establishing methods of treating patients.
