The pericardium Exam:

I. II. III. IV.

Introduce yourself and take Permission. Insure the Position of the patient: patient sitting at a 45. Exposure: down to the Umbilicus.

Inspection:
A. General Inspection: B.

Pericardium Inspection:
Surgical Scars. Visible pulsation & Visible Apex beat. [you can do it while you are on your knees] Chest Deformities.

V.

Palpation:
General Palpation:
For General impulse, Masses and Tenderness. If cant located ask the patient to roll on to his left side. Note the position of the Apex beat [e.g: 5th intercostal space at the midclavicular line]. For left & right ventricular hypertrophy. Put your hand on the left parasternal and ask the patient to hold his breath. Mitral area. Tricuspid area. Pulmonary area. Aortic area. Over the Apex beat. Over the Left 4th intercostal. Over the Left 2nd intercostal. Over the Right 2nd intercostal.

Locate the Apex beat: Palpate for Heaves:

Palpate for thrills over the auscultatory areas:

VI.

Auscultation: S1 (Mitral & Tricuspid valve), S2 (Pulmonary & Aortic Valve).

Over the 4 auscultatory areas using the Bell & the Diaphragm Comment on:
S1 & S2. Added sound. Presence of Murmurs. Turn the patient to his left side and listen over the Apex using the Bell.

Mitral Stenosis Mid Diastolic murmur. Aortic Regurgitation Early Diastolic murmur.
Ask the patient to sit up & lean forward, breath out fully & hold his breath. Listen over the right 2nd intercostal & over the left sterna edge using the Diaphragm. Mitral Regurgitation Pan systolic murmur: Auscultate over the Axilla.

Aortic Stenosis Eject Systolic murmur: Auscultate over the Carotids.