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Accuracy of Precordial Palpation for Detecting Increased Left Ventricular Volume

STEVEN D. EILEN, M.D.; MICHAEL H. CRAWFORD, M.D.; and ROBERT A. O'ROURKE, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Steven D. Eilen, M.D.; Department of Medicine/Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive; San Antonio, TX 78284.


San Antonio, Texas


©1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(5):628-630. doi:10.7326/0003-4819-99-5-628
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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.

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