STEVEN D. EILEN, M.D.; MICHAEL H. CRAWFORD, M.D.; ROBERT A. O'ROURKE, M.D.
Objective data on the reliability of precordial palpation in detecting left ventricular enlargement are scarce. Therefore, we evaluated 41 patients by physical examination and two-dimensional echocardiography to determine the relation between the location of the apex and left ventricular end-diastolic volume. An apical impulse lateral to the mid-clavicular line or greater than 10 cm from the mid-sternal line was sensitive but not specific as an indicator of left ventricular enlargement. In patients without left ventricular hypertrophy, an apical diameter greater than 3 cm in the left lateral decubitus was sensitive (92%) and specific (91%) for an enlarged left ventricle. The positive and negative predictive values were 86% and 95% respectively. Therefore, the location of the apical impulse in relation to the mid-clavicular line or the mid-sternal line is not a reliable indicator of increased left ventricular end-diastolic volume. However, an apical impulse greater than 3 cm may be an accurate indicator of left ventricular enlargement.
EILEN SD, CRAWFORD MH, O'ROURKE RA. Accuracy of Precordial Palpation for Detecting Increased Left Ventricular Volume. Ann Intern Med. ;99:628–630. doi: 10.7326/0003-4819-99-5-628
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Published: Ann Intern Med. 1983;99(5):628-630.
Cardiac Diagnosis and Imaging, Cardiology.
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