Cardiomegaly physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor in Chief: Cafer Zorkun, M.D., Ph.D. [2]

A comprehensive physical examination with a thorough cardiac exam will reveal cardiomegaly, and may indicated the nature of the underlying cause. The body habitus of the individual needs to be taken into account when evaluating findings on cardiac examination.

There is downward and leftward displacement of the heart on percussion of heart border. The heart should be percussed with the patient supine and the head of the bed elevated 30 degrees. Normally the left heart border should not

• Extend left of the mid clavicular line.
• Extend more than 10 cm to the left of the mid sternal line.
• Occupy a diameter > 3 cms.
• Extend below the 5th intercostal space.

The body habitus of the individual must be taken into account in performing the examination.

• In athletic individuals who are thin, the impulse may be strongly transmitted.
• In muscular or obese patients, the impulse may be weakly transmitted.
• In patients with pectus excavatum, the apex can be displaced laterally.

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