What is Palpation, Percussion & Auscultation

Clinical examination of cardiovascular system:

A person suffering from heart disease may present with many symptoms, some of which may not appear to be apparently connected with cardiovascular system. Heart disease may be detected during a routine clinical examination, though the patient may not complain of any symptoms. Some symptoms are constantly encountered in heart diseases, which are dyspnea, palpitation, cardiac pain, GI symptoms, respiratory symptoms, and urinary symptoms. 
Clinical examination of the cardiovascular system undergoes through different processes and it consists the following examinations: 
1. Examination of the arterial pulses 
2. Recording of the blood pressure 
3. Inspection and palpation of the system 
4. Percussion
5. Auscultation.

Palpation, auscultation and percussion

Examination of Arterial Pulses:

The pulse is the lateral pressure exerted by the walls of the blood vessels. It forms an elastic coiling and recoiling type. The pulse has been felt by the tip of the three fingers ((index, middle, and ring finger). Middle finger feels the pulse, index finger varies the pressure on the artery whereas ring finger is used to prevent the retrograde pulsation from the palmar arch. The examiner should notice for the rate, rhythm, volume, tension, and character of the pulse to find out the abnormal changes or may be of any pathology.

The normal pulse rate is 70-80 beats/ minute. The pulses were felt all over the body, which are of, carotid artery pulse, superficial temporary artery pulse, brachial artery pulse, radial artery pulse, femoral artery pulse, posterior tibial artery pulse, popliteal artery pulse, dorsalis pedis, etc. Increase in pulse more than 100/min represents tachycardia and decrease in the rate less than 60/min represents bradycardia.

Recording of the Blood Pressure:

This is done by auscultatory method, in which subject’s blood pressure is measured by an apparatus called sphygmomanometer. Here subject’s hand is tied by the cuff present in the apparatus around the elbow and pressure is raised by the hand pump. Then as the pressure is being released the pulse beats have been auscultated with a stethoscope, noting down the appearance and disappearance of the sound. This has been noted as the systolic and diastolic pressure. Normal blood pressure is 120/80 mm of Hg. Increase in this pressure leads to hypertension and decrease in this pressure leads to hypotension.

Palpation and Inspection and:


Inspection and Palpation should be examined in good light, with chest bared, but without unnecessary exposure to chill, both in sitting and supine positions. During palpation notice the shape of the chest and pericardium and observe if there is any dyspnea and cyanosis. Subject should be examined for the pulsations of the veins, pulsations in the thoracic region, pulsations in the epigastrium, apex beat and the thrills and murmurs. Thrill is the palpable murmur.

Percussion:


In Percussion your left middle finger firmly in contact with the skin. Strike its middle phalanx with the tip of the right middle finger 2-3 times. The percussing finger should be relaxed and should not be lifted up more than 3 inches or so and the movement of the hand should be loose and at the wrist and the finger joints and not at the elbow. Notice two things while percussing 
(a) the feeling imparted to the percussed finger and 
(b) the sound produced, which differs both quantitatively and qualitatively.

Auscultation:


The auscultation takes a major role in the examination of the cardiovascular system. Here the heart sounds were being auscultated with the help of stethoscope. These sounds were heard due to the closure and opening of the valves present in the heart. 
There are four heart sounds to be heard and these sounds can be heard in four places around the heart. 

  •  Aortic area—2nd right intercostal space close to sternum 
  • Pulmonary —2nd left intercostal space near to sternum 
  • Tricuspid —Apex or xiphoid process of sternum 
  • Mitral area—5th right intercostal space in midclavicular line.


Nature of Sounds:

The sounds are rhythmic in nature and, first and second sounds were heard close in a short interval whereas, interval is long between the second and the first sounds. Third sound is heard immediately after the second sound, which is not audible usually, and the fourth sound hears just before starting of the first sound. The sounds which are heard is given below as follows:

  • First sound (S1)—Louder and resembles LUBB sound heard during the closure of AV valves in ventricular systole. 
  • Second sound (S2)—Not louder resembles DUBB sound heard during the closure of semilunar valves in ventricular diastole. 
  • Third sound (S3)—Not heard loud, occurs in rapid ventricular filling. 
  • Fourth sound (S4)—Not heard loud, occurs in atrial contraction.


Heart murmur is an abnormal sound that consists of a flow noise that is heard before, between, or after the normal heart sounds or that may mask the normal heart sounds.


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