Clinical Examination of the Heart

Updated on November 3, 2017
Martin Buuri profile image

Works for the University of Nairobi-Kenya in the Department of Medical Physiology,and currently pursuing a Masters degree in Immunology,

Investigations of the Cardiovascular System in Humans

Clinical Examination of the Heart

The time-honoured sequence of operations used in the clinical examination of any region or organ is inspection, palpation, percussion and auscultation. Put in more direct terms, you look at it, feel it, tap it, and finally listen to it (like a wrapped Christmas present). The heart is an ideal organ on which to practice this sequence, so persuade one of your group to strip to the waist and lie on the examination couch at an angle of about 45o.

(i) Inspection.

Look at the chest; if the light is suitable you may be able to detect a rhythmical movement near the left nipple, corresponding with the heart beat. You may also be able to see arterial pulsations in the neck region.

(ii) Palpation

(a) Standing on the right side of the subject, place the pulps of the fingers of your right hand lightly on the chest wall over the heart (the precordium). You should be able to feel the pulsation of the heart. The furthest point downwards and laterally at which this can be felt is called the apex beat; mark this with a ball point pen, and work out its position with respect to intercostal space and the mid-clavicular line.

(b) Place your right hand flat on the chest wall between the apex beat and the midline. With practice it is possible to make an assessment of the force of the heart's contraction (the cardiac impulse). In the resting healthy subject this is not very pronounced, but it is accentuated by exercise.

(iii) Percussion.

This is an important diagnostic technique which would you do well to master at an early stage. The procedure is to place the fingers of your left hand flat on the chest of the subject and strike the middle phalanx of the middle finger sharply with the tip of the middle finger of the right hand. The sound that is produced varies with the character of the structures that lie under the body wall. Try this technique on the right side of the chest, and work downwards until your hand is over the liver; you should be able to detect a change from resonant to dull in the percussion note. Then try to map out the outline of the heart and mark it on the skin with a pen.

(iv) Auscultation

Auscultation is a difficult technique, but it is of enormous importance and you should practice as much as possible. Stethoscopes vary in design, especially the form of the chest piece. There are two types: the bell, which is particularly good for lower-pitched sounds provided that it is applied lightly to the chest wall, and the diaphragm, which gives a greater overall sound intensity but emphasises the high-pitched sounds in particular. Many people find this the most useful for all purposes at first, but when their discrimination of the sounds is a particular persons conversation in a crowded room where many people may be in conversation simultaneously. The art of doing this must be acquired by practice.

There are two important heart sounds: the first ('LUBB') is associated with closing of the artrio-ventricular valves and the early part of ventricular contraction, and the second ('DUPP') is produced by closure of the pulmonary and aortic valves. The relative contribution of the valves to the sounds that are heard varies with the listening position, and selected areas are used for each. These areas do not correspond necessarily with the surface marking of the valve; they are simply the places in which the particular valve can be heard more distinctly.

Pulmonary area - 2nd left intercostal space, close to midline

Aortic area - second right intercostal space, close to midline

Tricuspid area - bottom of sternum

Mitral area - at the apex beat

Listen to these areas and note the difference in intensity and quality of the sounds that are heard. Note the time interval between the 1st and 2nd sounds of a cardiac cycle and between the 2nd sound of one cycle and the 1st sound of the next. Which of these intervals is longer?

Listen carefully over the pulmonary area to the 2nd heart sound (P2) and note the changes in this sound immediately after the subject completes a deep inspiration. The second sound appears to be composed of two separate sounds (splitting). How may this be explained?

Comments

    0 of 8192 characters used
    Post Comment

    • Martin Buuri profile image
      Author

      Martin 6 months ago from Nairobi

      Hahaha,that is very nice Betty,you wouldn't go wrong.Thank you for your compliment.

    • Annkf profile image

      Betty A F 6 months ago from Florida

      Very interesting article Martin. While reading this, I was trying to find my own heartbeat following some of the steps you listed. :)

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, owlcation.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: "https://owlcation.com/privacy-policy#gdpr"

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)