13.11
Assessment of the Cardiovascular System III: Palpation
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Q1: Where is the point of maximal impulse located and what does a displaced PMI indicate?
The point of maximal impulse (PMI) is located at the fifth intercostal space on the left midclavicular line. Palpate this area with the patient supine to assess heart size and function. A displaced PMI may indicate cardiac enlargement, suggesting underlying cardiac disease or structural abnormalities affecting ventricular function.
Q2: How do you measure jugular venous pressure and what does an elevated reading mean?
Position the patient at a 30-45 degree angle and locate the highest point of pulsation in the internal jugular vein. Measure the vertical distance from this point to the sternal angle. Normal JVP is 3-4 cm above the sternal angle. Elevated JVP can indicate right-sided heart failure or fluid overload.
Q3: What does capillary refill time assess and what is considered normal?
Capillary refill assesses peripheral perfusion and cardiac output by measuring how quickly blood returns to the nail bed after blanching. Squeeze the nail bed until it blanches, then release and observe the time for color to return. Normal refill time is less than 2 seconds; delayed refill suggests poor perfusion, shock, or peripheral vascular disease.
Q4: What are heaves and lifts, and what cardiac condition might they indicate?
Heaves and lifts are forceful chest wall movements palpated along the left sternal border during the thorax examination. These abnormal vibrations may indicate ventricular hypertrophy or other cardiac abnormalities. They represent increased force of ventricular contraction against the chest wall and suggest underlying cardiac pathology.
Q5: How do you assess pulse characteristics and what abnormalities should you identify?
Palpate the carotid, radial, and femoral arteries to assess pulse rate, rhythm, and force. Check for bradycardia (less than 60 beats per minute), tachycardia (greater than 100 beats per minute), absent pulses, and bounding pulses. These findings help evaluate cardiac function and peripheral perfusion status.
Q6: What does pitting edema indicate and how is it graded?
Pitting edema occurs when pressing the skin leaves a lasting depression, indicating venous return issues or fluid accumulation in tissues. Grade pitting edema from 1+ to 4+ based on severity and how quickly the depression resolves. Asymmetry in limb circumference may suggest venous thromboembolism, varicose veins, or lymphedema.
Q7: What do cold extremities suggest during cardiovascular assessment?
Cold hands and feet during palpation may suggest peripheral arterial disease, reduced cardiac output, or severe anemia. Assess extremity temperature alongside other findings like capillary refill and pulses to evaluate peripheral perfusion. Cold extremities combined with delayed capillary refill indicates compromised circulation requiring further investigation.