Praecordium Examination

Introduction Identification Explanation Consent Chaperone

(Patient exposure – top off, semi-supine, 45°)
Inspection
 Chest wall & axilla for scar (sternotomy, thoracotomy etc); deformity
(pectus excavatum, pectus carinatum)
 Abnormal chest movement
 Pacemaker
Palpation
 Apex beat (5th intercostal space & mid-clavicular line)
 heaves (vertical) & thrills (horizontal)
 Trachea
Auscultation – clean stethoscope
 Diaphragm – Aortic, Pulmonary, Tricuspid & Mitral area – palpate the carotid pulse simultaneously!
 Bell – Tricuspid & Mitral – palpate the carotid pulse simultaneously!
 Ask the patient to roll on to their left lateral position, relocate the apex beat, bell over Mitral & Axilla.
 Ask the patient to take a deep breath in & out, hold breath with empty lungs whilst diaphragm – Tricuspid &
Aortic
 Diaphragm – carotid on both sides for bruits (deep breath in & out, hold their breath)
Thank patient & let them redress

To complete the examination:

 examine peripherally for signs, check JVP, pulse, take BP & listen to both lung bases for crackles