R i g h t ven t ric le o cc u p ie s m o s t o f t h e a n t e r io r car di a c su r f a ce .
T h is c h a m b e r a n d p u l m o n a r y a r t er y f or m a w ed g e l ik e st ru ct u r e b e h i n d
a n d to th e le f t s ter n u m
c a r d i a c a p ex is t h e b o tt om c o rn er
o f t h e L V , w h i c h p ro d u c e s t h e
a p ic a l im p u l s e
a pex
A p ic a l im p u l s e is id e n t i f ie d d u ri n g
p a l p a t ion o f th e p re c o r d i u m a s t h e p o in t o f m a x i m a l im p u l se ( P M I)
PM 1 Fo u n d in 5 ᵗ ʰ in t e r c o s t a l sp a c e .
P M 1 n o t a l w a y s p a l p a b le , e v e n i n h e a l t h y p a t ien t . D e te c t ion is a f fec t ed b y
b o th t h e p a t ie n t 's b o d y h a b it u s a n d p o s i ti on .
In s u p i n e , d ia m et er of PM 1 1F O 2 .5 c m .
P a t ien t s w it h CO P D t h e P M I m ay n o t b e a t th e a p e x b u t in ✗ i p h o id or e p i g a stric a r e a
d u e t o R ig h t ven tr ic u l ar h y per t r op h y .
R a r e l y , in s it u s in v e r s u s a n d d e x tr o car d ia , t h e
PM 1 is lo c a t e d o n t h e rig h t sid e o f c h e st .
Situs inversus is a condition where internal organs are mirrored
from their normal positions, such as the heart on the right side.
Many individuals with this condition live healthy lives.
Dextrocardia is a condition where the heart is
situated on the right side of the chest instead ✗ ip h o i d
of the left. It can occur alone or in conjunction
with situs inversus. In some cases, it may not
cause any symptoms or health issues.
A P M 1 > 2 .5 c m is e v i d e n c e o f lef t v en t r ic u l a r h y p er t r o p h y ( L V F ) f r o m
h y p e r t e n s io n or a o r tic s t en o s is .
D isp la ce m en t of P M 1 la t e r a l t o t h e m id cl a v ic u l a r li n e o r > 10 c m la t e r a l
t o t h e m i d st er n a l li n e oc cu r s in L V H a n d i n v en t r i c u l a r d i la t a t i o n
f r o m M l o r H F .
, C a r d ia c c h a m b e r s , v a lu e s a n d C ir c u l a t i o n
A s th e h ea r t v a lv e s c lo se , th e h e a r t s o u n d s o f s , a n d 5 2 a r is e f r o m vi b r a t ion s
fro m t h e le a f l e t s , t h e a d j a ce n t c a r d i a c s t ructu r e s a n d t h e f l o w o f b l o o d .
In m o s t a d u l t s o v er 4 0 , t h e d ia st o lic s o u n d s o f 5 3 a n d S y a r e
p a t h ol o g i c a n d a r e rel a t e d to H F a n d a cu t e m y o ca r d i a l is c h e m i a .
5 3 co r re sp o n d s t o a n a b r u p t d e c e l er a t io n o f i n f lo w a c r os s t h e m it r a l
va l v e a n d a n S y t o in c r e a s e d le f t ven tr ic u l ar en d d i a st o li c s t if f n e s s w h ic h
d ecr ea ses co m p li a n c e .
, E v e n t s in c a r d i a c c y c le
H e a r t s er v e s a s a pu m p t h a t g en er a t e s p re ss u r e s a s th e ch a m b e r s con tra ct a n d rel a x .
S y st ol e is th e per iod o f v en t r i cu l a r co n t r a ct i o n .
p re ssu r e in le f t ven t r icl e a r ise s f r o m
le s s t h a n 5 m m H g in it s re s t i n g s t a t e
to a n o r m a l p e a k o f R om m H g .
A f t er t h e v e n t r i c le e j e c t m u ch o f its b lo o d
i n to t h e a o r t a , t h e p r e ssu r e le v e l s o f f
a n d st a r t s t o f a l l .
D i a st o le is t h e p er iod o f ve n t r ic u l a r re l a x a t i o n
v en t r icu l a r p re ssu r e f a lls f u r t h e r t o b e l o w 5 m m H g , a n d b lo o d f lo w s f r o m
a t r i u m t o ven t r ic le .
s y st ole = a o rt ic v a lu e is o p e n , a llo w in g ej ec t i on o f b lo o d f r o m t h e le f t
ven t r icl e in t o th e a o r t a . M i tr a l v a l u e is c l os e d ,p re v en t i n g b lo o d f r om
re g u r g it a t i n g b a ck in t o t h e le f t a t r i u m .
D ia s t o le = A o r t ic v a l v e is c l o s e d , p r ev en t i n g reg u r g i t a t i on o f b lo o d f r o m
t h e a o r t a b a c k i n to t h e le f t ven t ric le . T h e m it r a l v a l u e is op e n ,
a l l o w i n g b lo o d t o f lo w f r o m t h e le f t a t r i u m i n t o t h e
re l a x e d le f t v e n t r i cl e .
P u lm o n i c v a l u e c lo s e s a n d t h e t r icu s p i d v a l u e o p e n s a s b loo d f l o w s
in t o t h e rig h t a t r i u m .
s y st o le = p u l m o n ic v a l u e o p en s a n d t h e t r icu s p id v a l u e cl o se s a s
b lo o d is e j e c t e d f r o m t h e R V in t o t h e p u l m o n a r y a r ter y .
T h is c h a m b e r a n d p u l m o n a r y a r t er y f or m a w ed g e l ik e st ru ct u r e b e h i n d
a n d to th e le f t s ter n u m
c a r d i a c a p ex is t h e b o tt om c o rn er
o f t h e L V , w h i c h p ro d u c e s t h e
a p ic a l im p u l s e
a pex
A p ic a l im p u l s e is id e n t i f ie d d u ri n g
p a l p a t ion o f th e p re c o r d i u m a s t h e p o in t o f m a x i m a l im p u l se ( P M I)
PM 1 Fo u n d in 5 ᵗ ʰ in t e r c o s t a l sp a c e .
P M 1 n o t a l w a y s p a l p a b le , e v e n i n h e a l t h y p a t ien t . D e te c t ion is a f fec t ed b y
b o th t h e p a t ie n t 's b o d y h a b it u s a n d p o s i ti on .
In s u p i n e , d ia m et er of PM 1 1F O 2 .5 c m .
P a t ien t s w it h CO P D t h e P M I m ay n o t b e a t th e a p e x b u t in ✗ i p h o id or e p i g a stric a r e a
d u e t o R ig h t ven tr ic u l ar h y per t r op h y .
R a r e l y , in s it u s in v e r s u s a n d d e x tr o car d ia , t h e
PM 1 is lo c a t e d o n t h e rig h t sid e o f c h e st .
Situs inversus is a condition where internal organs are mirrored
from their normal positions, such as the heart on the right side.
Many individuals with this condition live healthy lives.
Dextrocardia is a condition where the heart is
situated on the right side of the chest instead ✗ ip h o i d
of the left. It can occur alone or in conjunction
with situs inversus. In some cases, it may not
cause any symptoms or health issues.
A P M 1 > 2 .5 c m is e v i d e n c e o f lef t v en t r ic u l a r h y p er t r o p h y ( L V F ) f r o m
h y p e r t e n s io n or a o r tic s t en o s is .
D isp la ce m en t of P M 1 la t e r a l t o t h e m id cl a v ic u l a r li n e o r > 10 c m la t e r a l
t o t h e m i d st er n a l li n e oc cu r s in L V H a n d i n v en t r i c u l a r d i la t a t i o n
f r o m M l o r H F .
, C a r d ia c c h a m b e r s , v a lu e s a n d C ir c u l a t i o n
A s th e h ea r t v a lv e s c lo se , th e h e a r t s o u n d s o f s , a n d 5 2 a r is e f r o m vi b r a t ion s
fro m t h e le a f l e t s , t h e a d j a ce n t c a r d i a c s t ructu r e s a n d t h e f l o w o f b l o o d .
In m o s t a d u l t s o v er 4 0 , t h e d ia st o lic s o u n d s o f 5 3 a n d S y a r e
p a t h ol o g i c a n d a r e rel a t e d to H F a n d a cu t e m y o ca r d i a l is c h e m i a .
5 3 co r re sp o n d s t o a n a b r u p t d e c e l er a t io n o f i n f lo w a c r os s t h e m it r a l
va l v e a n d a n S y t o in c r e a s e d le f t ven tr ic u l ar en d d i a st o li c s t if f n e s s w h ic h
d ecr ea ses co m p li a n c e .
, E v e n t s in c a r d i a c c y c le
H e a r t s er v e s a s a pu m p t h a t g en er a t e s p re ss u r e s a s th e ch a m b e r s con tra ct a n d rel a x .
S y st ol e is th e per iod o f v en t r i cu l a r co n t r a ct i o n .
p re ssu r e in le f t ven t r icl e a r ise s f r o m
le s s t h a n 5 m m H g in it s re s t i n g s t a t e
to a n o r m a l p e a k o f R om m H g .
A f t er t h e v e n t r i c le e j e c t m u ch o f its b lo o d
i n to t h e a o r t a , t h e p r e ssu r e le v e l s o f f
a n d st a r t s t o f a l l .
D i a st o le is t h e p er iod o f ve n t r ic u l a r re l a x a t i o n
v en t r icu l a r p re ssu r e f a lls f u r t h e r t o b e l o w 5 m m H g , a n d b lo o d f lo w s f r o m
a t r i u m t o ven t r ic le .
s y st ole = a o rt ic v a lu e is o p e n , a llo w in g ej ec t i on o f b lo o d f r o m t h e le f t
ven t r icl e in t o th e a o r t a . M i tr a l v a l u e is c l os e d ,p re v en t i n g b lo o d f r om
re g u r g it a t i n g b a ck in t o t h e le f t a t r i u m .
D ia s t o le = A o r t ic v a l v e is c l o s e d , p r ev en t i n g reg u r g i t a t i on o f b lo o d f r o m
t h e a o r t a b a c k i n to t h e le f t ven t ric le . T h e m it r a l v a l u e is op e n ,
a l l o w i n g b lo o d t o f lo w f r o m t h e le f t a t r i u m i n t o t h e
re l a x e d le f t v e n t r i cl e .
P u lm o n i c v a l u e c lo s e s a n d t h e t r icu s p i d v a l u e o p e n s a s b loo d f l o w s
in t o t h e rig h t a t r i u m .
s y st o le = p u l m o n ic v a l u e o p en s a n d t h e t r icu s p id v a l u e cl o se s a s
b lo o d is e j e c t e d f r o m t h e R V in t o t h e p u l m o n a r y a r ter y .
