What organs border the heart? Determination of the boundaries of relative cardiac dullness

When defining boundaries relative stupidity hearts first set the right border, then the left, and then the top.

To identify right border of relative cardiac dullness along the right midclavicular line, the upper limit of absolute dullness of the liver (or the lower limit of the lung) is established, which is normally located in the VI intercostal space (Fig. 39, a). After this, going up to the IV intercostal space (to get away from hepatic dullness masking cardiac dullness), the pessimeter finger is placed parallel to the desired border and moved towards the heart along the IV intercostal space (Fig. 39, b). A change in percussion sound from clear pulmonary to dull will indicate reaching the limit of relative dullness of the heart. It should be noted that the pessimeter finger should be moved a short distance each time so as not to miss the boundaries of cardiac dullness. The first appearance of dullness indicates that the inner edge of the finger has crossed the border and is already within the location of the heart. The right border is marked along the outer edge of the finger, facing the clear percussion sound. It is formed by the right atrium and is normally located in the IV intercostal space, protruding 1-1.5 cm beyond the right edge of the sternum.

Rice. 39. Determination of the boundaries of relative dullness of the heart:
a - preliminary stage (establishing the upper limit of absolute liver dullness);
b, c, d - definition of the right, left and upper boundaries, respectively;
d - dimensions of the diameter of the relative dullness of the heart.

Before installation left border of relative cardiac dullness it is necessary to determine the apical impulse (see Fig. 38), which serves as a guide. If it cannot be detected, percussion is performed in the 5th intercostal space starting from the anterior axillary line towards the sternum. The plessimeter finger is placed parallel to the desired boundary and, moving it, percussion blows of medium strength are applied until dullness appears. The mark of the left border of relative dullness is placed along the outer edge of the pessimeter finger, facing the clear percussion sound. Normally, it is formed by the left ventricle, is located in the 5th intercostal space at a distance of 1-1.5 cm medially from the left midclavicular line (Fig. 39, c) and coincides with the apical impulse.

When determining upper limit of relative cardiac dullness(Fig. 39, d) a finger-pessimeter is placed near the left edge of the sternum parallel to the ribs and, moving it down along the intercostal spaces, blows of medium force are applied until dullness appears. A mark is placed along the upper edge of the pessimeter finger, facing the clear percussion sound. The upper limit of the relative dullness of the heart is formed by the contour of the pulmonary artery and the appendage of the left atrium and is normally located on the third rib along the left parasternal line.

Normally, the distance from the right border of relative dullness to the anterior midline is 3-4 cm, and from the left - 8-9 cm. The sum of these distances (11-13 cm) represents the size of the diameter of the relative dullness of the heart (Fig. 39, e) .

The limits of relative cardiac dullness may depend on a number of factors, both extracardiac and cardiac in nature. For example, in people with an asthenic physique, due to the low position of the diaphragm, the heart takes a more vertical position (a hanging “drip” heart) and the limits of its relative dullness decrease. The same is observed with prolapse of internal organs. In hypersthenics, due to the opposite reasons (higher position of the diaphragm), the heart accepts horizontal position and the boundaries of its relative dullness, especially the left one, are increasing. During pregnancy, flatulence, and ascites, the limits of relative dullness of the heart also increase.

The shift in the boundaries of the relative dullness of the heart, depending on the size of the heart itself, occurs primarily due to the increase (dilatation) of its cavities and is only to some extent determined by the thickening (hypertrophy) of the myocardium. This can happen in all directions. However, significant expansion of the heart and its cavities is prevented forward by the resistance of the chest wall, and downward by the diaphragm. Therefore, expansion of the heart is possible mainly backwards, upwards and to the sides. But percussion reveals only expansion of the heart to the right, up and to the left.

An increase in the right border of the relative dullness of the heart is most often observed with expansion of the right ventricle and right atrium, which occurs with tricuspid valve insufficiency and narrowing of the pulmonary artery orifice. With stenosis of the left atrioventricular orifice, the border shifts not only to the right, but also upward.

A shift of the left border of the relative dullness of the heart to the left occurs with a persistent increase blood pressure V big circle blood circulation, for example hypertension and symptomatic hypertension, with aortic heart defects (aortic valve insufficiency, aortic stenosis). With aortic defects, in addition to the displacement of the left border of the relative dullness of the heart to the left, it also shifts down to the VI or VII intercostal space (especially with aortic valve insufficiency). A shift of the left border of relative dullness to the left and up is observed with bicuspid valve insufficiency.

Rice. 40. Normal (a), mitral (b) and aortic (c) configurations of the heart.

To determine the configuration of the heart, percussion is performed sequentially in each intercostal space: to the right of IV and above II, to the left of V and above - to II. In this case, the pessimeter finger is positioned, as usual, parallel to the expected dullness. The percussion blow should be of medium strength. The points obtained during percussion are connected to each other and, thus, the configuration of the heart is revealed (Fig. 40, a). It may vary depending on the nature of his pathology. Thus, with mitral heart defects (mitral valve insufficiency, mitral stenosis), the heart acquires a “mitral configuration” (Fig. 40, b). Due to the expansion of the left atrium and left ventricle, the waist of the heart is flattened due to an increase in the size of the left atrium. With aortic defects (aortic valve insufficiency, narrowing of the aortic opening), with pronounced forms of hypertension, the heart, as a result of isolated expansion of the left ventricle, acquires an “aortic configuration” - the appearance of a “boot” or “sitting duck” (Fig. 40, b). In the case of combined and combined defects, all parts of the heart may enlarge. When there is a very sharp displacement of the boundaries of the heart in all directions, it is called “bull”.

When examining the cardiovascular system, percussion determines the boundaries of the heart and the width of the vascular bundle.

The heart is mostly located on the left side chest and can be schematically represented as an obliquely located cone, the apex of which corresponds to the apex of the heart and is directed down and to the left, and the base is directed upward. Accordingly, the right, upper and left borders of the heart are distinguished, which are determined in this sequence. The heart muscle and the blood it contains are airless, low-elastic media. Therefore, over the area of ​​the anterior chest wall to the left of the sternum, to which the heart is directly adjacent, a dull sound occurs upon percussion (absolute cardiac dullness). The lungs surrounding the heart on both sides and above, on the contrary, are elastic media containing air and produce a clear pulmonary sound when percussed. On the right and above, the heart is partially covered by the thin edges of the lungs, therefore, during percussion, a dull percussion sound appears here, which is like a transition between a clear pulmonary sound and the sound of absolute cardiac dullness. This sound is called relative cardiac dullness.

Thus, when determining the right and upper borders of the heart, first a clear pulmonary sound turns into the sound of relative cardiac dullness (the border of relative cardiac dullness), and this, in turn, turns into the sound of absolute cardiac dullness (the border of absolute cardiac dullness). The boundaries of relative cardiac dullness correspond to the true boundaries of the heart. On the left, the heart is not covered by the lung, so the clear pulmonary sound immediately turns into the sound of absolute cardiac dullness. The area of ​​absolute cardiac dullness is formed mainly by the right ventricle adjacent directly to the anterior chest wall. Only a narrow strip of absolute dullness along the left contour of the heart is formed by the left ventricle. The lines along which the size of the heart are determined are chosen in such a way that the expansion of each of the percussion boundaries reflects the increase in certain chambers of the heart: the right border - the right ventricle; upper - left atrium; left - left ventricle. The percussion method cannot detect an increase in the size of the right atrium.

Adjacent to the heart is Traube’s “semilunar space,” which is bounded on the right by the left edge of the liver, on the left by the spleen and below by the left costal arch. In the projection of this space there is an air “bubble” of the stomach, so percussion produces a tympanic sound.

In accordance with the rules of topographic percussion, when determining the boundaries of the heart, the plessimeter finger is placed parallel to the desired boundary and percussed in the direction from clear sound to dull sound, i.e. from the lungs to the heart. To determine the boundaries of relative cardiac dullness, percussion blows of medium strength are used, and when determining the boundaries of absolute cardiac dullness, quiet percussion blows are used. Percussion is best performed with the patient in an upright position or in a sitting position with legs down. The patient's breathing should be shallow and even. The found percussion border is fixed with a pessimeter finger and its coordinates are determined on the chest: the right border - by palpation of the edges of the sternum; top - by counting the ribs; left - by measuring the distance to the left midclavicular line. It should be remembered that the percussion boundary corresponds to the edge of the pessimeter finger facing towards a clearer sound.

Right border of the heart usually determined at the level of the fourth intercostal space. However, you must first make sure that the level of determination of the right border of the heart lies in a sufficiently wide zone of clear pulmonary sound. To do this, first find the lower percussion border right lung along the midclavicular line. The pessimeter finger is placed directly under the right clavicle and parallel to it so that the middle phalanx of the finger is on the right midclavicular line (the woman is asked to right hand lift and retract the right mammary gland outward). Using quiet percussion blows, they percussion along the indicated line along the ribs and intercostal spaces in the direction from top to bottom until the border of the transition of a clear pulmonary sound into a dull sound is detected (Fig. 9, a). The found boundary is fixed with a pessimeter finger and its localization is determined by counting the edges. Normally, the border lies on the VI rib and corresponds to the lower edge of the right lung and the upper edge of the liver. It is advisable to mark the border with a dermograph, as it will be needed later when determining the size of the liver.

Clinical experience shows that the distance from the fourth intercostal space to the sixth rib is sufficient so that dense liver tissue does not affect the accuracy of determining the right border of the heart. Extension of the border of the liver upward is observed extremely rarely, since it is suspended in abdominal cavity on the ligaments and with increase, mainly the lower border of the zone of hepatic dullness expands. More realistic reasons that can interfere with the determination of the right border of the heart may be right-sided pleural effusion or massive consolidation of the right lung, since a dull percussion sound is detected above them. Similar pathological processes will prevent the determination of other cardiac boundaries.

To determine the right border of the heart, a pessimeter finger is placed along the right midclavicular line so that its middle phalanx is located in the fourth intercostal space. Using percussion blows of medium strength, they percussion at this level towards the sternum, moving the plessimeter finger by a distance of 0.5-1 cm after each pair of blows and holding it in a position parallel to the desired border (Fig. 9, b). The transition of a clear pulmonary sound to a dull one corresponds to the right border of relative cardiac dullness. Normally, it is located along the right edge of the sternum. Next, using already quiet percussion blows, they continue percussion at the same level until the boundary of the transition of a dull sound into a dull sound is detected, which corresponds to the right border of absolute cardiac dullness. Normally, it runs along the left edge of the sternum. If an enlargement of the right border of the heart is detected, percussion is performed in a similar way at the level of the fifth intercostal space to establish a possible connection between this phenomenon and effusion into the pericardial cavity.

Rice. 9. Initial position of the finger-pessimeter and the direction of its movement during percussion determination of the upper border of the liver (a), right (b), upper (c) and left (d) borders of the heart

Upper limit the heart is determined by the left parasternal line. The pessimeter finger is placed directly under the left clavicle and parallel to it so that the middle phalanx of the finger is on the indicated line. Using percussion blows of medium strength, they percussion along this line along the ribs and intercostal spaces in the direction from top to bottom (Fig. 9, c). The transition of a clear pulmonary sound to a dull one corresponds to the upper limit of relative cardiac dullness, which is normally located on the III rib. Then, using already quiet percussion blows, they continue to percussion along the same line downwards until a dull sound appears, which corresponds to the upper limit of absolute cardiac dullness. Normally it is located on the IV rib.

Left border of the heart determined at the level of the intercostal space in which the apex beat was visually or palpably detected. If there is no apical impulse, then by counting the ribs to the left of the sternum, the fifth intercostal space is found and percussion is performed at this level. Before performing percussion on a woman, the doctor, if necessary, asks her to lift the left mammary gland with her right hand. It is difficult to determine the left border of the heart, since it is necessary to percussion along the rounded surface of the chest. The pessimeter finger is installed longitudinally along the left anterior axillary line so that, firstly, its middle phalanx is located in the intercostal space selected as the percussion level, and, secondly, the finger itself is located strictly in the frontal plane and pressed tightly to the chest its palmar surface and ulnar edge. Percussion is performed at the level of the selected intercostal space towards the sternum, delivering quiet percussion blows in the sagittal plane, i.e. strictly perpendicular to the dorsal surface of the plessimeter finger. After each pair of percussion blows, the finger-pessimeter is shifted in the medial direction by a distance of 0.5-1 cm, while maintaining its longitudinal position and holding it strictly in the frontal plane (Fig. 9, d). The transition of a clear pulmonary sound directly into the sound of absolute cardiac dullness (bypassing the sound of relative cardiac dullness) indicates the detection of the left border of the heart. Normally, it is located at the level of the fifth intercostal space 1.5-2 cm medially from the left midclavicular line and coincides with the location of the outer edge of the apex beat. In order to determine the degree of mobility of the heart in the chest, it is advisable to repeat the study of the right and left borders in a supine position, and then on the right and left sides.

A uniform expansion of the borders of cardiac dullness to the right indicates the presence of hypertrophy and dilatation of the right ventricle, and upward - dilatation of the left atrium. With hypertrophy and dilatation of the left ventricle, the left border of the heart expands. Moderate expansion of the left border of the heart can also occur with severe dilatation of the right ventricle. Simultaneous expansion of the left and right borders of the heart most often indicates dilatation of both ventricles. When fluid accumulates in the pericardial cavity, expansion of the left and right borders of the heart also occurs, often with the disappearance of the zone of relative cardiac dullness on the right. However, in this case, the most pronounced expansion of the right border of the heart is determined not in the fourth, but in the fifth intercostal space. In addition, with significant effusion into the pericardial cavity, the left border of the heart sometimes does not coincide with the apex beat, but is located outside of it.

The results of determining the percussion boundaries of the heart can be influenced by pathological processes in the respiratory system. Patients with pulmonary emphysema are characterized by a uniform narrowing of the boundaries of the zone of absolute cardiac dullness or even its complete disappearance. Cicatricial wrinkling or collapse (atelectasis) of a section of lung tissue adjacent to one or another part of the heart, on the contrary, leads to an expansion of the corresponding border of absolute cardiac dullness. Moreover, if these processes in one of the lungs are widespread and lead to a displacement of the mediastinum, the right and left borders of the heart shift towards the lesion. When fluid or air accumulates in one of the pleural cavities, the mediastinum shifts to the healthy side. In this case, upon percussion on the side opposite to the effusion or pneumothorax, an expansion of the border of the heart is noted, while on the affected side, percussion phenomena caused by the pathological process will interfere with the determination of the border of the heart: a dull sound with pleural effusion and tympanitis with pneumothorax.

When performing percussion in a horizontal position of the patient, the borders of the heart are slightly wider than when performing percussion in a standing position. Moreover, in the lateral position, the right and left borders of the heart shift in the corresponding direction by 2-3 cm. The absence of displacement of the borders of the heart, as well as the displacement of the apical impulse when changing body position, indicates the presence of adhesions of the pericardium with the surrounding tissues. With dextrocardia, the borders of the heart are projected onto the right half of the chest and are, as it were, a mirror image of the borders already described when it is located on the left side.

Vascular bundle width determined by percussion at the level of the second intercostal space, first on one side of the sternum, and then on the other. The pessimeter finger is positioned longitudinally along the midclavicular line so that its middle phalanx lies in the second intercostal space. Using quiet percussion blows, they percussion at this level towards the edge of the sternum, holding the pessimeter finger in a longitudinal position and shifting it after each pair of blows by 0.5-1 cm until the border of the transition of a clear pulmonary sound into a dull sound is detected (Fig. 10). Normally, the width of the vascular bundle does not extend beyond the edges of the sternum. The expansion of the percussion boundaries of the vascular bundle is observed mainly with the expansion of the aorta, which makes up its main part.

Rice. 10. Initial position of the pessimeter finger and the direction of its movement during percussion determination of the width of the vascular bundle

Determination of the right border of relative cardiac dullness. Place the pessimeter finger in the 2nd intercostal space along the right midclavicular line. First, the height of the diaphragm (the lower border of the lung) is determined. To do this, percussion is performed with a weak percussion blow down the intercostal space until the pulmonary sound disappears and a dull sound appears. The border is marked on the side of the pessimeter finger facing the clear pulmonary sound. Place your finger on the rib above. At a normal height of the diaphragm, the pessimeter finger will be in the 4th intercostal space. Place the pessimeter finger on the midclavicular line parallel to the right edge of the sternum. Carry out percussion, applying blows of medium force towards the edge of the sternum until the pulmonary sound disappears and a dull sound appears. The right limit of relative cardiac dullness will be determined. It is formed by the right atrium. U healthy person the right border of the relative dullness of the heart is located in the IV intercostal space and is 1.5-2 cm from the right edge of the sternum.

Defining the left border relative stupidity hearts. It begins with palpation of the apical impulse, after which the finger-pessimeter is placed vertically in the V intercostal space 1-2 cm outward from the outer edge of the apical impulse. If the apical impulse is not detected, percussion is carried out in the 5th intercostal space from the left mid-axillary line, applying blows of medium strength until the pulmonary percussion sound disappears and a dull sound appears. The established border is marked along the edge of the pessimeter finger on the side of the clear pulmonary sound. The left border of the relative dullness of the heart is formed by the left ventricle and coincides with the outer edge of the apex beat. Normally, the left border of the relative dullness of the heart is located in the 5th intercostal space 1-1.5 cm medially from the midclavicular line.

Determination of the upper limit of relative cardiac dullness. Place the pessimeter finger under the left collarbone parallel to the ribs so that the middle phalanx is directly at the left edge of the sternum. Apply percussion blows of medium strength. When the pulmonary sound disappears and the percussion sound appears, mark the border along the upper edge of the plessimeter finger (i.e., along the edge of the finger facing the clear pulmonary sound). The upper limit of relative dullness is formed by the conus pulmonary artery and the left atrial appendage. Normally, the upper limit of relative dullness runs along the upper edge of the third rib.

Changes in the percussion boundaries of the heart may be due to:

Changes in the size of the heart or its chambers;

Changes in the position of the heart in the chest.

Shift of the right border of relative dullness of the heart to the right. This displacement occurs in pathological conditions accompanied by dilatation of the right atrium or right ventricle. The border may shift to the right with exudative pericarditis and hydropericardium.

Shift of the left border of the relative dullness of the heart to the left. This displacement occurs in pathological conditions accompanied by dilatation of the left ventricle. A dilated right ventricle in some cases can “push” the left ventricle outward, which causes a shift of the left border of the relative dullness of the heart to the left.

Shift of the upper limit of the relative dullness of the heart upward. This displacement occurs when the left atrium and/or conus pulmonary artery dilates.

The heart is the main organ of the human body. It is a muscular organ, hollow inside and cone-shaped. In newborns, the heart weighs about thirty grams, and in an adult it weighs about three hundred.

The topography of the heart is as follows: it is located in the chest cavity, and one third of it is located on the right side of the mediastinum, and two thirds on the left. The base of the organ is directed upward and somewhat posteriorly, and the narrow part, that is, the apex, is directed downward, to the left and anteriorly.

Organ boundaries

The boundaries of the heart allow us to determine the location of the organ. There are several of them:

1. Upper. It corresponds to the cartilage of the third rib.
2. Bottom. This border connects right side with the top.
3. The top. located in the fifth intercostal space, towards the left midclavicular straight line.
4. Right. Between the third and fifth ribs, a couple of centimeters to the right of the edge of the sternum.
5. Left. The topography of the heart at this border has its own characteristics. It connects the top with upper limit, and itself passes along which is facing the left lung.

According to topography, the heart is located behind and just below half of the sternum. The largest vessels are located behind, in the upper part.

Topography changes

The topography and structure of the heart in humans changes with age. IN childhood the organ makes two revolutions around its axis. The boundaries of the heart change during breathing and depending on the position of the body. So, when lying on the left side and bending over, the heart approaches the chest wall. When a person stands, it is located lower than when he lies. Because of this feature it shifts. According to anatomy, the topography of the heart changes and as a result breathing movements. So, as you inhale, the organ moves further away from the chest, and as you exhale, it returns back.

Changes in the function, structure, topography of the heart are observed in different phases cardiac activity. These indicators depend on gender, age, and also on individual characteristics body: location of the digestive organs.

Structure of the heart

The heart has an apex and a base. The latter faces up, to the right and back. At the back the base is formed by the atria, and at the front - by the pulmonary trunk and large artery- aorta.

The top of the organ faces down, forward and to the left. According to the topography of the heart, it reaches the fifth intercostal space. The apex is usually located at a distance of eight centimeters from the mediastinum.

The walls of the organ have several layers:

1. Endocardium.
2. Myocardium.
3. Epicardium.
4. Pericardium.

The endocardium lines the organ from the inside. This tissue forms the valves.

The myocardium is the heart muscle that contracts involuntarily. The ventricles and atria also consist of muscles, and in the former the muscles are more developed. The superficial layer of the atrium muscles consists of longitudinal and circular fibers. They are independent for each atrium. And in the ventricles there are the following layers muscle tissue: deep, superficial and medium circular. From the deepest part, fleshy bridges and papillary muscles are formed.

The epicardium is the epithelial cells covering outer surface and the organ and nearby vessels: aorta, vein, and also the pulmonary trunk.

The pericardium is the outer layer of the pericardial sac. Between the leaves there is a slit-like formation - the pericardial cavity.

Holes

The heart has several holes and chambers. The organ has a longitudinal septum that divides it into two parts: left and right. At the top of each part are the atria, and at the bottom are the ventricles. There are openings between the atria and ventricles.

The first of them have some protrusion, which forms the cardiac ear. The walls of the atria have different thicknesses: the left one is more developed than the right one.

Inside the ventricles there are papillary muscles. Moreover, there are three of them on the left, and two on the right.

Fluid enters the right atrium from the superior and inferior pudendal veins and the veins of the sinus of the heart. Four lead to the left. From the right ventricle, the aorta leaves and from the left.

Valves

The heart has tricuspid and bicuspid valves that close the gastroatrial openings. The absence of reverse blood flow and eversion of the walls is ensured by tendon threads passing from the edge of the valves to the papillary muscles.

Bivalve or mitral valve closes the left ventricular-atrial orifice. Tricuspid - right ventricular-atrial opening.

In addition, in the heart there is one that closes the opening of the aorta, and the other that closes the pulmonary trunk. Valve defects are defined as heart disease.

Circulation circles

IN human body There are several circles of blood circulation. Let's look at them:

1. The great circle (BC) starts from the left ventricle and ends at the right atrium. Through it, blood flows through the aorta, then through the arteries, which diverge into precapillaries. After this, the blood enters the capillaries, and from there to the tissues and organs. In these small vessels, nutrients are exchanged between tissue cells and blood. After this, the reverse flow of blood begins. From the capillaries it enters the postcapillaries. They form venules, from which venous blood enters the veins. Along them it approaches the heart, where the vascular beds converge into the vena cava and enter the right atrium. This is how the blood supply to all organs and tissues occurs.
2. The pulmonary circle (PV) starts from the right ventricle and ends at the left atrium. Its origin is the pulmonary trunk, which divides into a pair pulmonary arteries. Venous blood flows through them. It enters the lungs and is enriched with oxygen, turning into an arterial one. The blood then collects in the pulmonary veins and flows into the left atrium. MCC is intended to enrich the blood with oxygen.
3. There is also a coronal circle. It starts from the aortic bulb and the right coronary artery, passes through the capillary network of the heart and returns through the venules and coronary veins, first to the coronary sinus and then to the right atrium. This circle supplies nutrients to the heart.

The heart, as you can see, is a complex organ that has its own circulation. Its boundaries change, and the heart itself changes its angle of inclination with age, turning around its axis twice.

The location of any organ in the human body is determined genetically and obeys certain rules. For example, in humans the heart is usually located on the left side of the chest, and the stomach is on the left side of the abdominal cavity. Location and boundaries of any internal organ can be identified by a specialist by palpation and. The boundaries of the heart are determined by tapping the chest with your fingers. This method is called cardiac percussion.

Although the most informative in identifying instrumental studies, tapping often helps to make a preliminary diagnosis even during initial examination sick.

Usually the human heart is located on the left side of the chest, slightly obliquely, and appearance resembles a cone. The organ is partially covered from above and from the sides by the lungs, in front by the chest, below by the diaphragm, and behind by the mediastinal organs.

The anatomy of the borders of the heart is revealed by the sound that the doctor hears when tapping the chest wall:

• percussion of the cardiac region is usually accompanied by a dull sound;
• tapping the lung area - clear pulmonary.

During the procedure, the specialist gradually moves his fingers from the front of the sternum to its center, and marks the border at the moment when the pulmonary sound is replaced by a characteristic dull sound.

Types of borders

It is customary to distinguish two types of boundaries of cardiac dullness:

• Absolute limit is formed by an open area of ​​the heart, and when it is tapped, a duller sound is heard.
• Limits of relative dullness located in places where the heart is slightly covered by areas of the lungs, and the sound that is heard when tapped is dull.

Norm

The boundaries of the heart normally have approximately the following values:

• Right the border of the heart is usually found in the fourth intercostal space on the right side of the chest. It is determined by moving the fingers from right to left along the fourth space between the ribs.
• Left located along the fifth intercostal space.
• Upper located along the third intercostal space on the left side of the chest.

The superior cardiac border indicates the location of the left atrium, and the right and left respectively. When tapping, it is not possible to identify only the location of the right atrium.

The heart rate limit in children varies according to the stages of maturation, and becomes equal to the values ​​​​of adults when the child reaches twelve years of age. Thus, up to two years, the left border is located 2 cm outward in the left part of the midclavicular line, the right border is along the right parasternal line, and the upper border is in the area of ​​the second rib.

From two to seven years, the left border is located 1 cm outward from the left part of the midclavicular line, the right one moves to the inner part of the right parasternal line, and the upper one is located in the second intercostal space.

From the age of seven until the age of twelve, the left border is located on the left along the midclavicular line, the right border is along the right edge of the chest, and the upper one shifts to the area of ​​the third rib.

The norm of cardiac boundaries in adults and children gives an idea of ​​where the cardiac boundaries should be. If the borders of the heart are not located where they should be, one can assume hypertrophic changes in any part of the organ due to pathological processes.

The causes of cardiac dullness are usually as follows:

• Pathological enlargement of the myocardium or right ventricle, which is accompanied by significant expansion right border.
• Pathological enlargement of the left atrium, which results in displacement of the upper cardiac border.
• Pathological enlargement of the left ventricle, due to which the left border of the heart expands.
• Hypertrophic changes in both ventricles simultaneously, in which both the right and left cardiac boundaries are displaced.

Of all the listed deviations, the most common is a displacement of the left border, and it is often caused by persistent, against the background of which a pathological enlargement of the left side of the heart develops.

In addition, changes in cardiac boundaries can be provoked by pathologies such as congenital cardiac anomalies, previous inflammatory process in the heart muscle or cardiomyopathy, which developed as a result of disruption of the normal functioning of the endocrine system and hormonal imbalance against this background.

In many cases, expansion of the cardiac boundaries is due to disease of the heart lining and abnormalities in the functioning of neighboring organs - for example, the lungs or liver.

Uniform expansion of the boundaries is often caused by pericarditis - inflammation of the pericardial layers, which is characterized by excess fluid in the pericardial cavity.

Unilateral displacement of the borders of the heart to the healthy side most often occurs against the background of excess fluid or air in the pleural cavity. If the cardiac borders are shifted to the affected side, this may indicate collapse of a certain area of ​​lung tissue (atelectasis).

Due to pathological changes in the liver, which are accompanied by a significant increase in the organ’s size, there is often a shift of the right cardiac border to the left.

Dullness of the heart

If, during an examination, a specialist reveals abnormally changed borders of the heart in a patient, he tries to determine as accurately as possible whether the patient has manifestations characteristic of cardiac pathologies or diseases of nearby organs.

Symptoms of cardiac dullness in most cases are as follows:

• Heart disease is characterized by swelling of the face and legs, palpitations, painful sensations in the chest and both when walking and at rest.
• Lung pathologies are accompanied by cyanosis skin, shortness of breath and cough.
• Liver dysfunction can be manifested by an enlarged abdomen, stool disturbances, edema and jaundice.

Even if the patient does not have any of the above symptoms, violation of the boundaries of the heart is an abnormal phenomenon, so the specialist must prescribe the necessary additional examination to the patient.

Usually additional diagnostics includes an electrocardiogram, chest x-ray, heart, endocrine glands and abdominal organs, as well as examining the patient’s blood.

Treatment

Treatment of enlarged or displaced boundaries of the heart is impossible in principle, since the main problem is not so much the violation of the boundaries as the disease that provoked it. Therefore, first of all, it is necessary to determine the cause that caused hypertrophic changes in the cardiac sections or displacement of the heart due to diseases of nearby organs, and only then prescribe suitable therapy.

The patient may need surgery in order to eliminate heart defects, stenting or bypass surgery to prevent recurrent infarction.

In addition, sometimes it is prescribed drug treatment– diuretics, medications for reducing heart rate and lowering blood pressure, which are used to prevent further enlargement of the heart.