Bintari Anindhita (09-058)

KEPANITERAAN ILMU PENYAKIT DALAM PERIODE 22 Juli - 21 September 2013 FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN INDONESIA JAKARTA

normally found in the 5th interspace 7 cm to 9 cm lateral to the midsternal line, typically at or just medial to the left midclavicular line In supine patients the diameter of the PMI approximately 1 to 2.5 cm.
A PMI greater than 2.5 cm is evidence of left ventricular hypertrophy (LVH), or enlargement. Displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line also suggests LVH, or enlargement.

1.

Right border: does not exceed the right border of the sternum Left border: 5th intercostal space in the left midclavicular line

1.

S1

S2 S1

Nearly always pathologic when heard in people older than 40 Occur in early diastole 12-20 s after S2 Best heard at:
Originating from left ventricle apex Originating from right ventricle 4th ics

adjacent to the sternum

Occur when ventricle reaches its elastic limit during early diastolic filling

Occurs in late diastole 0,4 12 s prior to S1

Best heard at:
Left heart apex
Right heart 4th ics adjacent to the sternum

Produced by atrial contraction against a stiff, non-compliant ventricle (ventricular hypertrophy)

Pansystolic murmur Systolic Systolic Ejection Murmur Murmur Early diastolic murmur

Diastolic
Mid-diastolic murmur

1.
2.

The murmur is only audible on listening carefully for some time.

The murmur is faint but immediately audible on placing the stethoscope on the chest.

3. 4. 5.

A loud murmur readily audible but with no palpable thrill.

A loud murmur with a palpable thrill. A loud murmur with a palpable thrill. The murmur is so loud that it is audible with only the rim of the stethoscope touching the chest. A loud murmur with a palpable thrill. The murmur is audible with the stethoscope not touching the chest but lifted just off it.

6.

Bates Guide to Physical Examination and History Taking Guyton & Hall Textbook of Medical Physiology