Interactive Guide to Physical Examination

Inspection and Palpation of the Precordium

Physicians are often tempted to rely on auscultation alone for evaluation of the heart. Inspection and palpation are equally important. Their value, however, depends on a thorough understanding of cardiovascular physiology, the skill of the examiner, and the ability to integrate findings from this portion of the exam with all other components.


Note any changes in the thorax that might impact on intrathoracic structures. In addition, look for any inward or outward pulsations paying particular attention to the apical area, the left sternal border, and the base of the heart in the 2nd right and left intercostal spaces.

View video Click on the video icon for a discussion and demonstration of inspection of the precordium.


Palpation of the precordium is a very important technique to master. Palpation is performed to evaluate the characteristics of the right and left ventricular impulse. Palpation should include evaluation of the apical area, the parasternal area, the right and left 2nd intercostal space, and the epigastric area.

First you will need to find the apical impulse. Note the size, location, duration, and amplitude of the apical impulse as this will provide you with information about the left ventricle. Next you will want to see if you can palpate an S3 or S4. The best location for feeling these impulses is in the apical area or near the lower left sternal border with the patient in the left lateral decubitus position.

Palpate the parasternal area along the left sternal border to assess the right ventricular impulse. Next, palpate the epigastric area for right ventricular pulsations, and the right 2nd and left 2nd intercostal spaces.

View video Click on the video icon for a discussion and demonstration of palpation of the precordium.