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PHYSICAL EXAMINATION OF THE HEARTPHYSICAL EXAMINATION OF THE HEART
INSPECTION:INSPECTION:> cyanosis> cyanosis--
centralcentral
or peripheralor peripheral- cardiac or pulmonary?- cardiac or pulmonary?> bulge or deformity over chest> bulge or deformity over chest 
 
 
PHYSICAL EXAMINATION OF THE HEARTPHYSICAL EXAMINATION OF THE HEART
PALPATION:PALPATION:
- peripheral pulses- peripheral pulses
brachial a.- neonates & infantsbrachial a.- neonates & infantstemporal a.temporal a.femoral a.femoral a.dorsalis pedis a.dorsalis pedis a.posterior tibial a.posterior tibial a.
- pulses: sharp rise, firm, well localized- pulses: sharp rise, firm, well localized
 
 
PHYSICAL EXAMINATION OF THE HEARTPHYSICAL EXAMINATION OF THE HEART
PALPATION:PALPATION:PMIPMI
(point of maximal impulse)(point of maximal impulse)neonate – 4neonate – 4
thth
left ICS MCLleft ICS MCL> 2y.o. - 5> 2y.o. - 5
thth
left ICS MCLleft ICS MCL
precordial bulge – cardiac enlargementprecordial bulge – cardiac enlargementsubsternal thrust – R ventricular enlargementsubsternal thrust – R ventricular enlargementapical heave – L ventricular hypertrophyapical heave – L ventricular hypertrophyhyperdynamic precordium – large shuntshyperdynamic precordium – large shunts- maybe normal in thin patients- maybe normal in thin patients
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