(This is a Written Question Of Final Professional MBBS ( Medicine) Examination of Bangladesh)
- Obese person
- Thick muscular chest wall
- Soft tissue (breast)
- Emphysema
- Pericardial effusion
- Dextrocardia
Other Things you Need to Know.
Precardium: Palpation
* Palpate the precordium with the palmar surface of your hand over the aortic, pulmonary, parasternal and apical areas of the heart.
* Determine the lower and outermost precardiac impulse, the apical impulse.
* Press your finger over the apical impulse identify its location, amplitude, duration and assess the rapidity of the upstroke and downstroke.
Normal: In thin individuals, the apical impulse is recognizable. Apical impulse is normally in 5th interspace just medial to midclavicular line and is about 1-2 cm in diameter. The apical impulse feels like a gentle tap and is small in amplitude and corresponds to first two thirds of systole.
