Left 5th intercostal space

Mid clavicular line

Mid clavicular line
Outer most lower most part of heart =Midway between acromion process &
Visible, Palpable sternoclavicular joint
formed mainly by left ventricle Or
Site = mid-Inguinal point

For example
Right ventricular Enlargement Shifted downward
5th space anterior axillary line

For example
Causes of Shifted apex Left ventricular Enlargement Shifted outward & downward
7th space anterior axillary line

Pregnancy
‫أﺳﺒﺎب ﺗﺎﻧﻴﻪ وﻟﻜﻦ اﻟﻘﻠﺐ ﺳﻠﻴﻢ‬
Pleural effusion

Normal
Localised
Abnormal Left ventricular Enlargement
Palpation with one finger tip How to examine Extent

Right ventricular Enlargement

❤
Hyperdynamic circulation
Suprasternal
❤
Anemia Diffuse
Aortic regurge
Cannot be localised by 2 fingers
‫اﻣﺘﻰ أﺷﻮﻓﻬﺎ‬
Aortic aneurysm 60-100 /min

High arch of Aorta

Rate Atrial fibrillation rate >radial rate
With 2 fingertips at
Right 2nd ICS >10 Atrial fibrillation +uncontrolled ventricular rate
Pulsus deficit
Aortic
❤Extra-systole
Aortic aneurysm
‫اﻣﺘﻰ اﺣﺴﻬﺎ‬
<10 ❤Atrial fibrillation +Controlled ventricular rate
‫ﻓﻲ اﻟﺤﺎﻟﻪ دي ﺑﺴﻤﻊ ﺑﺎﻟﺴﺎﻋﻪ‬ by Medication
Palpable heart sound Aortic hypertension
Accentuated S2
Rhythm
With 2 fingertips at ‫دول اﻟﻄﺒﻴﻌﻲ ﻣﺶ ﺑﺤﺴﻬﻢ‬
Left 2nd ICS Apex ‫ﺑﺤﻂ اﻳﺪي ﻋﻨﺪ ال‬
How to examine
Pulmonary ‫واﻃﻠﺐ ﻣﻦ اﻟﻌﻴﺎن ﻳﻨﺎم ﻋﻠﻰ ﺟﻨﺒﻪ اﻟﺸﻤﺎل‬
Pulmonary aneurysm
‫اﻣﺘﻰ أﺣﺴﻬﺎ‬ Gentle
Palpable heart sound Normal One sustained tak
Accentuated S2 Pulmonary hypertension
‫اﻷﺻﻮات اﻟﻘﻮﻳﺔ ﺗﺤﺲ ﺑﺎﻟﻴﺪ‬ ‫ﻧﺒﻀﻪ ﺧﻔﻴﻔﻪ ﻣﺒﺘﻄﻮﻟﺶ‬

Right parasternal Aortic regurge

➡
Volume overload
Mitral regurge
Heals of hand Examined by ventricular Dilatation
Character Anemia
Hyperdynamic apex
Tricuspid regurge Apex Rapid rise & fall of apex
‫ﻗﻮﻳﻪ وﺳﺮﻳﻌﻪ‬
➡
VSD Volume overload
Dilatation
Left parasternal
➡
Pressure overload
Pulsation ‫ﺑﺤﺲ‬
‫ﻟﻜﻦ اﻳﺪي ﻣﺶ ﺑﺘﺘﺤﺮك‬
Palpation Sustained apex
Aortic stenosis
ventricular hypertrophy
Right ventricular Enlargement

Pulmonary stenosis
#cocci Abnormal
(Heavy apex)
Slow rise & fall of apex
‫ﻗﻮﻳﻪ وﺑﻄﻴﺌﺔ‬
➡
Pressure overload
Hypertrophy ‫اﻣﺘﻰ أﺣﺴﻬﺎ‬
Left parasternal Pulsation ‫ﺑﺤﺲ‬
heav or heaf ‫واﻳﺪي ﺑﺘﺘﺮﻓﻊ‬ Mitral stenosis
Accentuated S1
Slappy apex
Palpable S1
Left atrial Enlargement ‫ﺻﻔﻌﻪ‬

Obese
Cannot feel apex even with cardiomegally
COPD
using palm of hand in subxiphoid area How to examine
High grade mitral valve murmur Systolic
Epigastric
❤
Hepatic pulsation in
Right side
Tricuspid regurge pulsation
➡
Thrill ‫ﻟﻮ اﻟﻨﺒﺾ واﻻﻫﺘﺰاز ﺣﺼﻞ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ‬
Mitral regurge
Specific Systolic
Aortic aneurysm Below Pulsation hitting your hand from Apex ‫ﺣﻂ اﻳﺪك ﻋﻨﺪ ال‬
‫ﺣﺴﺐ ﻣﻜﺎﻧﻬﺎ‬
Carotid ‫واﻳﺪك اﻟﺘﺎﻧﻴﻪ ﻋﻨﺪ‬ ‫أﺛﻨﺎء ﻧﺰول اﻟﺪم ﻣﻦ اﻟﺬﻳﻦ ﻟﻠﺒﻄﻴﻦ‬
Right ventricular Enlargement Up & left ‫ﻟﻮ ﻣﺶ ﺑﻴﺤﺼﻠﻮا ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ‬
Mitral stenosis Stenosis ‫ﺑﻴﻄﻠﻊ ﺻﻮت ﻗﻮي ﻻن ﻓﻲ‬
Diastolic
Diastole ‫وﻧﺰول اﻟﺪم ﺑﻴﺤﺼﻞ أﺛﻨﺎء‬
Murmur =
‫ﺳﻤﻴﺖ ﻧﺴﺒﺔ إﻟﻰ اﺣﺴﺎﺳﻚ واﻧﺖ ﺣﺎﻃﻂ اﻳﺪك ﻋﻠﻰ‬ Abnormal pathway of blood Flow
‫ أرﻧﺐ‬،‫ ﻗﻄﻪ‬،‫ﺣﻤﺎﻣﻪ‬،... ‫ ﻣﻜﺎن ﻣﺶ ﻃﺒﻴﻌﻲ‬،‫ﺑﻴﻤﺮ ﻣﻦ ﻣﻜﺎن ﺿﻴﻖ‬ Systolic apical bulge
‫اﻟﻨﺒﺾ ﺑﺘﺎﻋﻬﻢ ﺑﻴﻜﻮن ﻗﻮي ﻓﺒﻴﺴﺒﺐ رﻋﺸﻪ ﻓﻲ‬ Stenosis, VSD
‫اﻟﺠﺴﻢ ﺑﻨﺤﺴﻬﺎ‬ Lateral ventricle Enlargement
Murmur ‫ﻋﺸﺎن اﺣﺲ ال‬ Parasternal Retraction
Murmur ‫ﻓﻲ ﺑﻌﺾ اﻟﻌﻴﺎﻧﻴﻦ ﺑﻴﻜﻮن ﻋﻨﺪﻫﻢ‬
‫ﻗﻮﻳﻪ ﺟﺪا ﺗﺴﺒﺐ رﻋﺸﻪ ﻓﻲ ﺟﺴﻤﻬﻢ‬
‫ﻻزم ﺗﻜﻮن ﻗﻮﻳﻪ‬ Rocking
Thrill =Palpable murmur Murmur ‫ ﻻزم ﻣﻌﺎه‬Thrill ‫إذن اي‬
Systolic Apical Retraction
‫ ﻣﺶ ﻻزم ﻳﻜﻮن ﻣﻌﺎه‬Murmur ‫واي‬
Thrill Right ventricle Enlargement
parasternal bulge

Obesity
Aortic stenosis Aortic area
Pericardial effusion
Systolic Pulmonary stenosis Pulmonary area ‫ ﻓﻲ أﻣﺎﻛﻦ ﺗﺎﻧﻴﻪ‬Thrill ‫ﻣﻤﻜﻦ أﺣﺲ‬
Absent apex Emphysema (COPD)
Opera
VSD Parasternal ‫ﻣﺶ ﻗﺎدر اﺷﻮﻓﻬﺎ أو اﺣﺴﻬﺎ‬
Ribs
‫اﻟﻀﻠﻮع ﻣﻐﻄﻴﺎﻫﺎ‬

Anomaly

Systolic - diastolic Myocardial aneurysm

Double apex
Systolic - Systolic Hypertrophic Obstructive Cardiomyopathy