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the heart
Surface anatomy of the heart
Surface anatomy
The position of the heart in the mediastinum
can be projected onto the overlying
skeleton
The heart is enclosed by a rectangle with
angles at left 5th intercostal space in
midclavicular line;2nd left costal cartilage;3rd
right
costal cartilage and 6th right costal
cartilage
Surface anatomy
• Right ventricle occupies most of the anterior
cardiac surface behind and to the left of the
sternum
• Left ventricle lies to the left and behind the right
ventricle.it makes only a small portion of the
anterior cardiac surface
• But it forms the border of the heart and produces
the apical impulse in 5th left intercostal space 7-9
cm from the mid sternal line
Surface Anatomy
• The right border of the heart is formed by
the right atrium;a chamber not usually
identifiable on physical examination
• The left atrium is most posterior and
cannot be examined directly
• But its small atrial appendage may make
up a segment of the left cardiac border
between the pulmonary artery and the left
ventricle
AUSCULTATORY AREAS
• They do not correspond with the surface
markings of the heart valves ,but are
areas where transmitted sounds and
murmurs are best heard
• Mitral valve:Apex (left 5th intercostal space)
• Tricuspid valve :Tricuspid area (lower left
sternal border )
AUSCULTATORY AREAS
• Aortic valve :Aortic area (2nd right
intercostal space )
• Pulmonary valve:Pulmonary area (2nd left
intercostal space )
INSPECTION AND PALPATION
• Patient position
– Supine, head elevated 30 degree
• From patient right side examine chest wall paying attention
to 5 areas
– Apex
– Epigastrium
– Left sternal border (right ventricular areas)
– Left 2nd intercostal space
– Right 2nd intercostal space
Inspection and palpation
• Look for
• Chest deformity
• Surgical scars
• Apex beat
• Visible pulsations
CHEST DEFORMITIES
• Precordial bulge
• Pectus excavatum :posterior displacement
of the lower sternum
• Pectus carinatum :Pigeon chest