What is a cardiac impulse? Health professionals are familiar with this concept. For those who are not related to medical activity, this definition says little. How to palpate to find out the location of a 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 to those who only want to learn the medical basics.
Heart beat
A cardiac impulse is a pulsation of a section of the anterior chest wall, which coincides with contractions of the heart. It may be visible during examination of the patient. Although in some cases the apical impulse may not be seen:
- with obesity;
- narrow intercostal spaces;
- developed musculature;
- large mammary glands.
It is best seen in people with an asthenic physique. In order to detect it, in addition to examination, the atrial region is palpated and the location of the cardiac impulse is determined, its properties are evaluated for additional information.
Palpation technique
The right hand is positioned in the projection of the proposed push, between the 3rd and 6th rib in the region of the apex of the heart. The pulsation is determined by the entire palmar surface, and then localized by the tip of the index finger. It must be installed perpendicular to the chest. With widespread pulsation, its leftmost and lower region is determined. This point is the place of the heart beat. By the way, they choose a place where the protrusion of the chest is determined by the flesh of the terminal phalanx of the palpating finger, and not by its lateral surfaces.
If it is difficult to feel the apical impulse of the heart due to the characteristics of the chest, then palpation is carried out with the chest canted forward, or the patient is laid on the left side. The muscle of the heart in these positions is closely adjacent to the chest and pushes the edge of the left lung.
In the position on the left side, the cardiac impulse falls below and to the left by 2 cm, therefore, the intercostal space where the contraction is determined, but 2 cm medial from the area of the impulse, is taken as the site of the push. Palpation of the apical impulse on the exhale increases the chances of determining its location, because when the diaphragm rises, 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 a cardiac impulse:
- location;
- resistance;
- prevalence;
- height.
Heart beat location
The contractions of the apex of the heart form a cardiac impulse. The apex lies slightly medial to the mid-clavicular line, in the 5th intercostal space on the left. It is located relatively freely and makes pendulum-like movements. If the position of the body changes, the localization of the shock is shifted. Some options for push bias have been described above.
When a person turns to the right side, a pronounced displacement of the atrial pulsation does not occur, 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, atrial pulsation can almost disappear.
Pathological displacement of heart pulsation
The ripple offset is divided into two types:
- Displacement not associated with cardiac pathology (pneumothorax, hydrothorax, wrinkling of the lung, emphysema, altered level of the diaphragm - 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 front 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.
Heart rate prevalence
The area of the protrusion of the heart beat is about 2 cm². If it turns out to be larger, then they speak of a spilled or widespread push. With a smaller area, it is limited.
A common pulsation occurs if the heart is adjacent to the chest wall with a larger surface. This is observed:
- with a deep breath;
- pregnancy
- with mediastinal tumors , etc.
In the absence of these conditions, a spilled impulse may result from the expansion of the heart (all or any of its departments).
Limited cardiac impulse occurs when a smaller heart is adjacent to the chest. The reason for this may be:
- emphysema;
- low standing aperture;
- pericardial effusion ;
- hydro-, pneumopericardium.
Heart beat height
The height of the heart beat is the amplitude of the pulsating portion 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 apical impulse. It also occurs with tachycardia, due to thyrotoxicosis, fever, in smokers, with severe stress.
Resistant cardiac impulse is a pulsation that gives a feeling of a thick, dense muscle during palpation, which is not easily amenable to pressure by the hand. So, if it is also spilled, strong, then it is defined as a domed apical impulse. Normally, it is not determined, but is formed with aortic defects or hypertension, when left ventricular hypertrophy develops .
Negative cardiac impulse
The retraction of the chest wall in the region of the cardiac impulse during systole is a negative apical impulse. It appears with a pronounced expansion of the right ventricle, which pushes back the apex of the left ventricle. Its systolic contraction can form a similar phenomenon.
Retraction of the intercostal spaces occurs with adhesive pericarditis.
Other ripples
Diagnostically significant pulsations are pulsation of the aorta, pulmonary artery and epigastric pulsation. The first of them is imperceptible in the norm. Pathological pulsation appears in the II intercostal space on the right at the edge of the sternum. The causes of its occurrence include:
- wrinkling of the right lung;
- aortic expansion (syphilis, ascending aortic aneurysm, aortic valve defects).
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 detected in the epigastric fossa. The reasons for its appearance:
- prolapse of the right ventricle;
- abdominal aortic aneurysm.
Conclusion
The above research methods are important for the practitioner, however, due to the development of hardware diagnostics, the commitment of doctors to determine pathology by examination and palpation has significantly decreased over the past decades.
However, the need to continue the above practices is very great. Professionals who determine the apical impulse by palpation should be encouraged and more actively disseminate information about the application of this method in medicine.
In many cases, the use of palpation led to positive results, including early diagnosis of the disease. The apical impulse determined by a specialist (normal and with various pathologies) is a serious indicator for establishing treatment methods for patients.