Palpation of the praecordium
With pulmonary hypertension, the second sound may become so loud that it is palpable in the pulmonary area - to the left of the sternum, in the 4th interspace. Feel here with the flat of the hand. With hypertrophy of the right ventricle, a thrusting sensation or ?heave? may be palpable along or just to the left of the sternum. Both of these will be accentuated when the patient leans forward, throwing the right ventricle up against the sternum.
Therefore feel for a palpable P2 (pulmonary component of the second sound) and for a right ventricular heave with the patient lying back initially, but thereafter with the patient leaning forwards. Use the palm of your hand and the surface of your fingers to detect these abnormalities.
| AFRIKAANS | TRANSCRIPT | XHOSA |
|---|---|---|
| I?m going to feel your heartbeat. / Ek gaan nou u hartklop voel. / Ndiza kuva ukubetha kwentliziyo yakho. | ||
| Okay? / Reg so? / Kulungile? | ||
| Thank you. / Baie dankie. / Enkosi. | ||
| Now please sit forward so I can do it again. / Sit asseblief vorentoe sodat ek dit weer kan doen. / Ngoku nceda uhlalele phambili ukuze ndiphinde kwakhona. | ||
| Thank you. / Baie dankie. / Enkosi |
A hypertrophied right ventricle may also give rise to a pulsation in the epigastrium, below the sternum. Feel here too.
| AFRIKAANS | TRANSCRIPT | XHOSA |
|---|---|---|
| I?m not finished yet. / Ek is nog nie klaar nie. / Andikagqibi. | ||
| I need to feel your heart here please. / Ek moet hier voel vir u hartklop, asseblief. / Ndicela ukuva intliziyo yakho apha. |
