Question

1. You have just completed the physical assessment on a patient who is complaining of weight gain, swollen feet and ankles, and increasing dyspnea. When you palpate her point of maximum impulse (PMI), it is felt in the left midaxillary line at the fifth intercostal space. What does this finding indicate?

   		This finding is expected.
   		The heart has shifted.
   		There is left ventricular enlargement.
   		There is right ventricular enlargement.

Answer 1

The PMI or point of maximum impulse , it is listen at the apex of heart, normally located at fifth intercostal space at midclavicular line.

It gets shifted in case of ventricles abnormalities such as ventricle enlargement in which the maximum impulse is displaced laterally, it is located near by the axilla. In client finding it is located at mid axillary line which is shifted laterally as seen anatomicallly.

Now the symptoms in right and left ventricle enlargement have common one thing which is dyspnoea.

Sweeping in ankles, feet is sign and symptoms of right ventricular hypertrophy. This is due to involvement of pulmonary circulation.

Hence the symptoms indicat right ventricular enlargement.

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