Percussion of the heart
Last reviewed: 23.04.2024
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Percussion of the heart supplements the information obtained by palpation. In the region of the adherence of the heart to the anterior thoracic wall, dullness is determined percussionily. Since part of the heart contour is covered by the lungs, in this area the percussion sound will be muffled less than in the area where the heart is directly in contact with the chest wall, so the so-called relative and absolute cardiac dullness is determined. When determining the relative cardiac dullness, its right border is found at the level of the fourth intercostal space, along the edge and not further than 1 cm outward from the edge of the sternum. During percussion, the finger (plessimeter) is placed parallel to the desired boundary and moves along a line perpendicular to it.
The left border of relative dullness of the heart is determined near the apical impulse, and in its absence in the fifth intercostal space (percussive in the fifth intercostal space from the anterior axillary line towards the sternum). The left border of relative dullness of the heart is located 1 cm inward from the left sredneklyuchichnoy line.
To determine the upper limit of the relative dullness of the heart, the finger-plessimeter is moved along a line parallel to the edge of the sternum, starting to percut from the second rib. Normally, the upper limit of relative cardiac dullness corresponds to the lower edge of the 3rd rib or the third intercostal margin.
The boundaries of the absolute stupidity of the heart correspond to the following landmarks: the left one - 1-2 cm inward from the border of relative dullness of the heart, the right one - along the left edge of the sternum at the level of the fourth intercostal space, the upper one - the fourth intercostal space. In determining these boundaries, percussion begins from the center of the zone of absolute stupidity of the heart, percussion impacts produce very gently so that the sound in the area of absolute dullness is practically unheard. In this case, when the boundary between absolute and relative dullness is reached, the percussion sound becomes audible.
The definition of the vascular bundle boundaries is made at the level of the second intercostal space. The finger-plessimeter is moved along a line perpendicular to the edge of the sternum. In doing so, also use quiet percussion. The boundaries of the stupidity of the vascular bundle correspond in norm to the edges of the sternum.
The right contour of the relative dullness of the heart and the vascular bundle is formed starting from the top, i.e. From the second intercostal space, the superior vena cava, then the right atrium. The left contour of the relative stupidity of the heart is formed by the arch of the aorta, then by the pulmonary artery at level III of the rib of the auricle of the left atrium and below the narrow stripe of the left ventricle. The anterior surface of the heart in the region of absolute dullness forms the right ventricle.
The informativeness of the data obtained in the study of the precardial region is now assessed rather critically. This is due to the fact that as a result of the often occurring emphysema of the lungs, most of the heart is covered by the lungs, and it is almost impossible to determine the boundaries of relative and absolute dullness. The displacement of the apical impulse and the left border of the heart from the outside can often be associated with an increase in different chambers of the heart, but not the left ventricle. A significant increase in cardiac stupidity with percussion is found with a large pericardial swelling. A significant shift of the border up can occur with an increase in the left atrium due to mitral defects. Expansion of the vascular bundle is observed with aortic aneurysm.
The impression obtained in the study of the precardial zone is confirmed by the results of modern very informative methods, primarily echocardiography.
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