Precordial examination

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Precordial examination
Auscultation of the Heart 001.jpg
Main auscultation points for heart.
(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

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In medicine, the precordial exam, also cardiac exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology.

The exam includes several parts:

  • position / lighting / draping
  • inspection
  • palpation
  • auscultation

Position / Lighting / Draping

Position - patient should be supine and the bed or examination table should be at a 45 degree angle. The patient's hands should remain at her sides with her head resting on a pillow.

Lighting - adjusted so that it is ideal.

Draping - the chest should be fully exposed.

Inspection

Patient should be examined for

Palpation

The valve area are palpated for abnormal pulsations (known as thrills) and precordial movements (known as heaves). Heaves are best felt with the heel of the hand at the sternal border.

Palpation of the apex beat

The point of apex beat is typically in the fifth intercostal space and 1cm medial to the mid-clavicular line. It should be described by the following characteristics (which can be remember with the mnemonic SALID:

  • S - Size - Is it larger than one interspace?
  • A - Amplitude - Is it weak?
  • L - Location - Is it in the fifth intercostal space at the mid-clavicular line?
  • I - Impulse - Is it monophasic or biphasic?
  • D - Duration - Is it abnormally sustained?

The best to describe apex beat is the point that has the most lateral and most inferior of apex pulsation.

Auscultation

One should comment on

  • S1 and S2 - if the splitting is abnormal or louder than usual. Should sound like [lub-dub lub-dub]

and the presence of

  • S3 - think Kentucky - the emphasis and timing of the syllables in the word Kentucky is similar to the pattern of sounds in a precordial S3. Some examiners can hear these sounds better by listening for a [T-lub dub] sound.
  • S4 - think Tennessee - the emphasis and timing of the syllables in the word Tennessee is similar to the pattern of sounds in a precordial S4. Some examiners can hear these sounds better by listening for a [lub-de-dub] sound.
  • If S4 S1 S2 S3 were all present it would sound like [T-lub-de-dub] Also known as a gallop rhythm
  • diastolic murmurs (e.g. aortic insufficiency, mitral stenosis)
  • systolic murmurs (e.g. aortic stenosis, mitral regurgitation)
  • pericardial rub (suggestive of pericarditis)

Video: Examination of Cardiovascular System

See also

Cost Effectiveness of Precordial examination

| group5 = Clinical Trials Involving Precordial examination | list5 = Ongoing Trials on Precordial examination at Clinical Trials.govTrial results on Precordial examinationClinical Trials on Precordial examination at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Precordial examination | list6 = US National Guidelines Clearinghouse on Precordial examinationNICE Guidance on Precordial examinationNHS PRODIGY GuidanceFDA on Precordial examinationCDC on Precordial examination


| group7 = Textbook Information on Precordial examination | list7 = Books and Textbook Information on Precordial examination


| group8 = Pharmacology Resources on Precordial examination | list8 = AND (Dose)}} Dosing of Precordial examinationAND (drug interactions)}} Drug interactions with Precordial examinationAND (side effects)}} Side effects of Precordial examinationAND (Allergy)}} Allergic reactions to Precordial examinationAND (overdose)}} Overdose information on Precordial examinationAND (carcinogenicity)}} Carcinogenicity information on Precordial examinationAND (pregnancy)}} Precordial examination in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Precordial examination


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Precordial examination | list9 = AND (pharmacogenomics)}} Genetics of Precordial examinationAND (pharmacogenomics)}} Pharmacogenomics of Precordial examinationAND (proteomics)}} Proteomics of Precordial examination


| group10 = Newstories on Precordial examination | list10 = Precordial examination in the newsBe alerted to news on Precordial examinationNews trends on Precordial examination</small>


| group11 = Commentary on Precordial examination | list11 = Blogs on Precordial examination

| group12 = Patient Resources on Precordial examination | list12 = Patient resources on Precordial examinationDiscussion groups on Precordial examinationPatient Handouts on Precordial examinationDirections to Hospitals Treating Precordial examinationRisk calculators and risk factors for Precordial examination


| group13 = Healthcare Provider Resources on Precordial examination | list13 = Symptoms of Precordial examinationCauses & Risk Factors for Precordial examinationDiagnostic studies for Precordial examinationTreatment of Precordial examination

| group14 = Continuing Medical Education (CME) Programs on Precordial examination | list14 = CME Programs on Precordial examination

| group15 = International Resources on Precordial examination | list15 = Precordial examination en EspanolPrecordial examination en Francais

| group16 = Business Resources on Precordial examination | list16 = Precordial examination in the MarketplacePatents on Precordial examination

| group17 = Informatics Resources on Precordial examination | list17 = List of terms related to Precordial examination


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