PEMERIKSAAN FISIK

JANTUNG
Prof. Dr. dr. Idris Idham, Sp.JP9K), FACC, FESC, FIHA

Departemen of Kardiologi dan Kedokteran Vaskuler

Fakultas Kedokteran Universitas Indonesia
Pusat Jantung Nasional Harapan Kita

Meraba Arteri Karotis

Meraba Arteri Karotis

JANGAN LUPA AUSKULTASI!!
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Inspeksi Vena Jugularis

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Anatomi V.Jugularis

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Inspeksi pulsasi Vena Jugularis

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Skema pengukuran JVP

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Examine Precordium (Cardiac)

Inspect the precordium with the pt sitting at 45 degree angle with
shoulder horizontal.Look for scars,visible pulsation and chest
deformity
Lay your whole hand flat over the precordium to obtain a general
impression of cardiac activity
Locate the apex beat by laying your finger on the chest paralel to the
rib spaces.If you can not feel it,ask the pt to roll onto the left side
Feel for the right ventricle using the heel of your hand applied firmly
to the left parasternal position.Ask the pt to hold his breath in
expiration.
Palpate the thrill at the apex and both sides of the sternum.
If you hear a murmur feel again for a thrill using the flat of your
fingers while the pt is in the optimum position

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Examine Precordium
Inspect the precordium with the pt sitting at 45 degree angle with
shoulder horizontal.Look for scars,visible pulsation and chest deformity
Lay your whole hand flat over the precordium to obtain a general
impression of cardiac activity
Locate the apex beat by laying your finger on the chest paralel to the
rib spaces.(its about 2-2,5cm in diameter)If you can not feel it,ask the
pt to roll onto the left side
Feel for the right ventricle using the heel of your hand applied firmly to
the left parasternal position.Ask the pt to hold his breath in expiration.
Palpate the thrill at the apex and both sides of the sternum.
If you hear a murmur feel again for a thrill using the flat of your fingers
while the pt is in the optimum position

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Chizner MA.The Diagnosis of Heart Disease by Clinical Assesment Alone.Current Problems in

Cardiology;26:285-380,2001

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Relation between Heart & Chest wall

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Lines on Chest wall

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Precordium Catat/laporkan
Apakah ada kelaian bentuk dada:pectus
excavatum,carinatum,Barrel chest atau
normal,sikatriks bekas operasi/pacu jantung
Iktus kordis terlihat/teraba di garis apa
Apakah teraba normal,heaving,tapping atau
difus/diskinetik
Apakah teraba thrill
Besar jantung berdasarkan inspeksi,palpasi dan
perkusi

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Palpasi Jantung

Palpasi Jantung

(How to percuss the heart)

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Locate midsternal line,r/l sternal line,r/lmcl,left anterior axillary line,posterior axillary line
and mid axillary line
For the normal size heart Locate the lung-gastric border in the mc line(in the middle of
normal respiration),Locate point at 2cm above,lung-gastric border and percuss from
lateral left to medial.Point the sound changing from sonor to dull(this is the Left border of
the heart).For a big heart do it from the mid or lateral axillary line
Locate the right lung-liver border in the rmcl (in the middle of normal
respiration),,Locate 2 cm above,lung-liver border and percuss from lateral right to medial
and point where rhe sound change from sonor to dull.(This is the Right border of the
heart)
Percus from up side of the left sternal line to point the up side heart border(up side border)
Percuss from the left shoulder to sentral of the heart to judge the Left Atrial/Pulmonal
artery enlargement and also from up side down at the para-sternal line.
Note:In most case palpation has replaced percussiosion for estimation of cardiac size.If
you can not feel the apical impulse,hawever, percussion may suggest where to search
it.Occasioally percussion may be your only tool
(Sukaton U(Editor).Petunjuk tentang Riwayat Penyakit dan Pemeriksaan Jasmani,Bagian
I.P.D FKUI,Jakarta,cetakan ke2,1986.

Auskultasi Jantung

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Sinkronisasi Bunyi Jantung I dan

Pulsasi A.Karotis

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Memperjelas bunyi jantung dan

murmur Aorta

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Auskultasi jantung
Identifikasi bunyi jantung 1 dan 2
Identifikasi bunyi jantung 3 dan 4(fase
diastolik)
Bunyi jantung tambahan: Snap atau Klik
Murmur(Bising):Sistolik 6 gradasi atau
diastolik(early,mid atau presistolik)

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Gradasi bising sistolik

1.Heard by an expert in optimum condition

2.Heard by non-expert in optimum condition
3.Easily heard,no thrill
4.A loud murmur,with a thrill
5.very loud.often heard over wide area with
thrill
6.Extreemily loud,heard without sthetoscope

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MACAM-MACAM BISING

Terima Kasih