Apex beat is situated in the 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
Jugular Venous Pulse defined as the oscillating top of vertical column of blood in right IJV that reflects pressure changes in Right Atrium in cardiac cycle. Jugular Venous Pressure is the vertical height of oscillating column of blood
The patient should lie comfortably during the examination.
Clothing should be removed from the neck and upper thorax.
Patient reclining with head elevated 45 °
Neck should not be sharply flexed.
Examined effectively by shining a light tangentially across the neck.
There should not be any tight bands around abdomen
Observe the following
The level of venous pressure.
The type of venous wave pattern.
The level of venous pressure is measured using a centimeter ruler, measure the vertical distance between the angle of Louis (manubrio sternal joint) and the highest level of jugular vein pulsation.The upper limit of normal is 4 cm above the sternal angle.Add 5 cm to measure central venous pressure since right atrium is 5 cm below the sternal angle.
Normal CVP is < 9 cm H2O
Pulse is an imporatant vital sign that gives clue to the hemodynamic stability of patient.Medical professional should be thorough with proper technique for pulse examination.See the video to get idea about the radial pulse examination
Murmurs are produced due to abnormal turbulent blood flow across the heart valve.
The murmur of mitral stenosis is a mid diastolic rough rumbling murmur heard at the apex of heart with the bell of stethoscope, patient lying down in the left lateral position, breath held in expiration.
The bellow video can here the typical sound of mid diastolic rumbling murmur of mitral stenosis.
