Physical Finding |
Associated cardiac condition(s) |
Apex beat |
|
Thrusting / heaving (parasternal) |
Left ventricular hypertrophy |
Sustained |
Hypertrophic cardiomyopathy |
Tapping / palpable S1 |
Mitral stenosis |
Double systolic apical impulse |
Dyskinetic or aneurysmal left ventricle, hypertrophic cardiomyopathy |
Displaced lateral to mid-clavicular line |
Dilated cardiomyopathy, aortic regurgitation, mitral regurgitation |
Absent apex beat |
Pericardial effusion, emphysema, obesity |
Left parasternal lift |
Severe mitral regurgitation, left atrial enlargement, or ascending thoracic aortic aneurysm |
Right parasternal lift |
Severe tricuspid regurgitation, right ventricular hypertrophy |
Systolic apical thrill |
Mitral regurgitation |
Diastolic apical thrill |
Mitral stenosis |
Left parasternal thrill (Intercostal space 3 or 4) |
Ventricular septal defect |
Systolic basal thrill |
Aortic stenosis, pulmonary stenosis |
Diastolic basal thrill |
Aortic regurgitation, pulmonary regurgitation |
Chest wall |
|
Local costochondral& muscle tenderness (with direct pressure over joint) |
Costal chondritis |
Pain localized to swollen costochondral&costosternal joints |
Tietze’s syndrome |
Abdomen |
|
Pulsatile liver |
Tricuspid regurgitation |
Right upper quadrant tenderness |
Acute onset of right heart failure |
Hepatomegaly |
Right heart failure, tricuspid regurgitation, constrictive pericarditis |
Hepatojugular / abdominojugular reflux - Sustained rise in jugular venous pulse on pressing the right upper quadrant or central abdomen for >=10 seconds |
Right heart failure, tricuspid regurgitation, constrictive pericarditis |