Palpate for Localized Motion

The patient should now lie down so that all four main cardiac areas can be palpated. The examiner uses his or her fingertips to assess any localized motion. This technique is demonstrated in Figure 14-28.

The presence of a systolic impulse in the second intercostal space to the left of the sternum is suspect for pulmonary hypertension. This impulse is caused by the closure of the pulmonic valve under increased pressure. The presence of this impulse is suggestive of a dilated pulmonary artery, but it may also be felt in thin individuals without pulmonary hypertension.

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