Mario’s Loukas netter’s introduction to clinical procedures latest Edition Ebook PDF 2018
TAPPING (small area) or SLAPPING (diffuse)— When the accentuated first heart sound is pal pable in MS or tachycardia due to any cause, it is known as tapping apex beat (remember, heart sounds are not palpable in health). The palpating finger is not lifted and the S: is felt as distinct palpable shock. HYPOKINETIC — The thrust felt by the hand is minimal. It is found in acute myocardial infarc tion, pericardial effusion, constrictive pericarditis, myxoedema, peripheral circulatory failure.
NORMAL — Situated in the left 5th ICS, 1 /2″ inside the left MCL which is a brief gentle tap not exceeding a 25-paisa coin size, not much forceful but usually palpable with certainty. In chil dren, the apex beat is located in the left 4th ICS and in lean-tall persons, it is usually present in the left 6th ICS. There may be double kicking apex beat in IHSS (idiopathic hypertrophic subaortic stenosis or hy pertrophic cardiomyopathy) and ventricular aneurysm. ** Regarding the character of the apex beat, some clinicians prefer the terms ‘right ventricular (RV)’ or ‘left ventricular (LV)’ type. In LV type the apex goes downwards and outwards as well as there is a larger impulse (usually more than a 25-paisa coin), and the impulse is maximal at the apex; if there is a left parasternal impulse, it is asynchronous with the apex beat. Whereas in RV type, the apex goes outwards as well as there is production of left parasternal heave, and both are synchronous; in RV type, the cardiac impulse is maximal over the lower left sternal border. *** While palpating for pulsations, e.g., apex beat — use the pulp of the fingers; for thrills—use the base of the fingers; and for parasternal heaves—use the base of the hand (i.e., thenar and hypothenar eminences).
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