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In medicine, the precordial exam, also cardiac exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology.
The exam includes several parts:
- position/lighting/draping
- inspection
- palpation
- auscultation
Position/Lighting/Draping
Position - patient should be supine and the bed or examination table should be flat. The patient's hands should remain at her sides with her head resting on a pillow.Lighting - adjusted so that it is ideal.
Draping - the chest should be fully exposed.
Inspection
Patient should be examined for- masses
- scars
- lesions
- signs of trauma and previous surgery (e.g. median sternotomy)
Palpation
The valve area are palpated for abnormal pulsations (known as thrills) and precordial movements (known as heaves). Heaves are best felt with the heel of the hand at the sternal border.Palpation of the point of maximal impulse
The point of maximal impulse is typically in the fifth intercostal space in the mid-clavicular line. It should be described by the following characteristics (which can be remember with the mnemonic SALID:- S - Size - Is it larger than one interspace?
- A - Amplitude - Is it weak?
- L - Location - Is it in the fifth intercostal space at the mid-clavicular line?
- I - Impulse - Is it monophasic or biphasic?
- D - Duration - Is it abnormally sustained?
Auscultation
One should comment on- S1 and S2 - if the splitting is abnormal or louder than usual.
- S3 - think Kentucky - the emphasis and timing of the syllables in the word Kentucky is similar to the pattern of sounds in a precordial S3.
- S4 - think Tennessee - the emphasis and timing of the syllables in the word Tennessee is similar to the pattern of sounds in a precordial S4.
- diastolic murmurs (e.g. aortic insufficiency, mitral stenosis)
- systolic murmurs (e.g. aortic stenosis, mitral reguritation)
- pericardial rub (suggestive of pericarditis)
See also
"Precordial examination"