Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. Source: Wellcome Collection.

    511/616 (page 483)
    PART II—PHYSICAL EXAMINATION OF THE HEART. In the physical examination of the heart the same methods of investigation are employed as in the case of the lungs, viz., Inspection, Palpation, Percussion, and Auscultation. It is of great importance for the beginner to practice fre- quently the EXAMINATION OF THE NORMAL HEART. The first point of importance for the student to note is the contour of the chest-wall in front of, and enclosing the organ. In the healthy chest the left is usually symmetrical with the right side, but, as will afterwards be seen, certain diseases may cause alterations in respect of this symmetry, which may have a diagnostic importance. Having inspected the precordial region, and having noted the fact of any visible pulsation, whether diffused over the cardiac area, or localised to the apex- region, the epigastrium, or other part of the chest, the next point to determine, if possible, is the exact position of the apex- beat. In many cases this corresponds with a visible pulsation which will have been noted in the preliminary survey, but in not a few instances no such distinct pulsation is seen, and care- ful search by palpation must be made for the apex. In all cases, whether there is a visible apex-beat or not, the intercostal spaces in the precordial region should be separately examined with the tips of the index and middle fingers, in order to fix if possible the exact spot at which the apex, or rather the most superficial part of the left ventricle, strikes the chest wall. The most favourable opportunity for this is in expiration, when, by the recession of the lung, the heart approximates itself most closely to the ribs; but the state of expiration must not be long maintained, otherwise the apex-beat becomes obscure from other causes (see foot-note, p. 487). In the normal chest, in the recumbent posture, the apex-beat is usually found in the fifth intercostal space, slightly inside the vertical line of the nipple. It is to be remembered, how-