title: Accuracy of precordial palpation for detecting increased left ventricular volume.
abstract: 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.
mesh_terms: D000328:Adult; D000368:Aged; D006332:Cardiomegaly / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography; D005069:Evaluation Studies as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D013318:Stroke Volume