Table 5: Palpation of chest and abdomen

Physical Finding Associated cardiac condition(s)
Apex beat
Thrusting / heaving (parasternal) Left ventricular hypertrophy
Sustained Hypertrophic cardiomyopathy
Tapping / palpable S1 Mitral stenosis
Double systolic apical impulse Dyskinetic or aneurysmal left ventricle, hypertrophic cardiomyopathy
Displaced lateral to mid-clavicular line Dilated cardiomyopathy, aortic regurgitation, mitral regurgitation
Absent apex beat Pericardial effusion, emphysema, obesity
Left parasternal lift Severe mitral regurgitation, left atrial enlargement, or ascending thoracic aortic aneurysm
Right parasternal lift Severe tricuspid regurgitation, right ventricular hypertrophy
Systolic apical thrill Mitral regurgitation
Diastolic apical thrill Mitral stenosis
Left parasternal thrill (Intercostal space 3 or 4) Ventricular septal defect
Systolic basal thrill Aortic stenosis, pulmonary stenosis
Diastolic basal thrill Aortic regurgitation, pulmonary regurgitation
Chest wall
Local costochondral& muscle tenderness (with direct pressure over joint) Costal chondritis
Pain localized to swollen costochondral&costosternal joints Tietze’s syndrome
Pulsatile liver Tricuspid regurgitation
Right upper quadrant tenderness Acute onset of right heart failure
Hepatomegaly Right heart failure, tricuspid regurgitation, constrictive pericarditis
Hepatojugular / abdominojugular reflux - Sustained rise in jugular venous pulse on pressing the right upper quadrant or central abdomen for >=10 seconds Right heart failure, tricuspid regurgitation, constrictive pericarditis