Cardiovascular System Examination: Percussion

I. Cardiac Borders

Purpose:

• Estimate the heart’s size and position by defining areas of cardiac dullness.

Technique:

• Percuss systematically from resonant lung tissue toward areas of dullness to delineate borders.

Key Cardiac Borders:

• Right Heart Border:

  • Normally aligns with the right sternal border.

  • Dullness below may merge with hepatic dullness.

  • Deviations to the right may indicate severe right ventricular enlargement or dextrocardia.

• Left Heart Border:

  • Normally corresponds with the apex beat (left 5th intercostal space, medial to the mid-clavicular line).

  • Lateral or inferior displacement suggests cardiomegaly (ventricular enlargement).

• Upper Border:

  • Typically located at the 3rd costal cartilage on either side of the sternum.

Findings:

• Normal Cardiac Dullness: Present / Absent

• Increased Cardiac Dullness: Present / Absent (e.g., cardiomegaly, pericardial effusion)

• Displaced Cardiac Dullness: Present / Absent

  • Specify direction and probable cause (e.g., mediastinal shift, dextrocardia)

II. Other Relevant Percussion Areas

1. Liver Dullness and Hepatic Span:

• Percuss upper and lower liver borders at the mid-clavicular line to estimate span (normal: 6-12 cm).

• Relevance: Hepatomegaly (enlarged liver) is a potential sign of right-sided heart failure.

• Findings:

  • Normal / Enlarged (specify measured span)

  • Tenderness on percussion: Present / Absent

2. Right 2nd Intercostal Space (ICS):

• Percuss for dullness in this location.

• Relevance: Increased dullness may indicate a dilated ascending aorta (e.g., aortic aneurysm, severe aortic regurgitation).

3. Mediastinal Dullness:

• Assess for broadening of mediastinal dullness.

• Relevance: Widening may point to mediastinal masses or significant aortic dilatation.