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Intersection of Life and Faith

Examining our Heart

  • Dr. Cherry
  • 2001 11 Nov
  • COMMENTS
Examining our Heart
Why does a doctor thump on your chest? Why does he move his stethoscope around in so many different positions? One of the most important exams a physician performs is the examination of the heart. The Bible says, "the life is in the blood" (Leviticus 17:11). We are trained as doctors to stand at the right side of a patient as we begin our examination. We first simply look at the chest area (inspection). We might look for the apical impulse. This is usually in the fifth rib space, 7-9 cm. from the middle of the breastbone. If the amplitude or intensity of this impulse is increased, it can be caused by thickening of the large pumping chamber of the heart, often due to high blood pressure or valve disease. If the location is shifted to the left, it can indicate a dilation or increased size of the heart. A bulge near the upper part of the breastbone can be caused by an aneurysm or enlargement of the large blood vessel that exits the heart (the aorta). If there is a prominent pulsation noted in the lower portion of the heart, this may simply be normal but occasionally can indicate a displacement of the heart caused by emphysema.

If we suspect a problem, we will often place our hand on the chest wall (palpation) and feel for the point of maximum impulse of the heartbeat. If it moves too far to the left, it can indicate thickening in the left ventricle and enlargement in the pumping chamber, which can be caused by congestive heart failure and other problems. Again, this can also be a clue to the effects of high blood pressure or valve problems in the heart. Sometimes we will take our fingers and "thump" along the chest wall (percussion), which can help us detect the overall size of the heart, air in the lungs or collapse of the lungs, emphysema, or fluid in the sack that surrounds the heart (pericardial effusion).

Most familiar to patients is when the physician takes the stethoscope and begins listening to the heart. We are evaluating several things as we listen through the stethoscope; we can detect atrial fibrillation, which is an irregular rhythm in the small chambers in the top of the heart, and we can also detect clues to malfunction of the heart's built-in pacemaker. We can also detect premature or irregular beats in the large pumping chamber of the heart. The heart has four different valves, and we position the stethoscope in various areas over the chest wall, as each valve tends to radiate a maximum sound to a unique area. We can detect thickening in the valves as well as leakage around the valves (often detected in the form of a murmur).

Careful listening, for example, over an area to the left of the breastbone can help us detect mitral valve prolapse, which is a bulging in the valve more frequently seen in women. Extra sounds such as "quick clicks or snaps" can give us further clues to valve problems. Many heart murmurs (which are simply sounds a doctor hears through the stethoscope) are benign and mean absolutely nothing. Long distance runners, for example, will often develop a heart murmur. Murmurs, however, can be signs of serious valve problems, thyroid problems, and anemia among other things. Certain other sounds, known as friction rubs, can give us a clue to inflammation in the sack that surrounds the heart. God designed the heart to have the unique pattern sounds (S1 and S2 heart sounds). If additional heart sounds are heard (S3 or S4), a doctor can detect problems with the contractions of the heart muscle, thickening in the heart muscle, thickening in one of the valves, such as the aortic valve, high blood pressure, or even a heart attack. In conjunction with the heart examination, I always take the stethoscope and move up to the neck area to check the arteries in the neck (carotid arteries) for abnormal sounds that could indicate blockage or fat buildup that would affect blood flow to the brain.

God designed the heart to function in a majestic, orderly pattern and has revealed to us that pattern. By careful examination of the heart, we can detect deviation from God's design, which give us important clues to problems that may be developing with the heart. The sooner these are detected and the better we understand the problem, the sooner we can develop our Pathway to Healing for these problems.


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