The technique of percussion is discussed in Chapter 13, The Chest. Percussion of the heart is performed at the third, fourth, and fifth intercostal spaces from the left anterior axillary line to the right anterior axillary line. Normally, there is a change in the percussion note from resonance to dullness about 6 cm lateral to the left of the sternum. This dullness is attributable to the presence of the heart.
A percussion dullness distance of greater than 10.5 cm in the left fifth intercostal space has a sensitivity of 91.3% and a specificity of 30.3% for detecting increased left ventricular end-diastolic volume (LVEDV) or left ventricular mass. Percussion dullness of more than 10.5 cm in the fifth intercostal space has a sensitivity of 94.4% and a specificity of 67.2% in detecting cardiomegaly. In patients with a palpable apical impulse of greater than 3 cm in the left de-cubitus position, the sensitivity of detecting increased LVEDV or left ventricular mass increases to 100% and the specificity is 40%.
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