Physical examination maneuver
Physical Exam
Precordial Palpation
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How to Perform
With the patient supine, palpate directly on skin with the finger pads for a thrill in the second intercostal space at the right sternal border, the second intercostal space at the left sternal border, the lower left sternal border at the fourth or fifth intercostal space, and the fifth intercostal space at the left midclavicular line. Then place the heel of your hand firmly over the lower left parasternal region, over or just to the left of the sternum, and feel for a sustained systolic lifting impulse or heave.
How to Interpret
Showing 5 of 7 findings
Chronic Obstructive Pulmonary Disease
Subxiphoid cardiac impulse
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Pulmonary Embolism
Left parasternal heave
Rule in
Somewhat helpfulWide CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Pulmonary Hypertension
Left parasternal heave (sustained right ventricular lift)
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Sustained left parasternal (right ventricular) heave
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Palpable P2 (pulmonary-valve closure)
Rule in
Not helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Related Bedside Tests
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
🎬Video coming soon
Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
🎬Video coming soon
Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
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Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
🎬Video coming soon
Lower Extremity Inspection and Palpation
Rule in:VHDiabetic Foot Osteomyelitis, VHKnee Osteoarthritis, HAchilles Tendon Rupture +7 more
Rule out:SHAchilles Tendon Rupture, SHDiabetic Foot Osteomyelitis, SHKnee Osteoarthritis +7 more
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Respiratory Rate
Rule in:HReduced Left Ventricular Ejection Fraction, SHCardiopulmonary Arrest, SHPneumonia +10 more
Rule out:MHCardiopulmonary Arrest, MHPulmonary Embolism, NHPneumonia +10 more