In which of the following patient categories would the intensity of the point of maximal impulse (PMI) be most difficult to palpate?
a. Chronic pulmonary hyperinflation
b. Mitral (bicuspid) stenosis
c. Left ventricular hypertrophy
d. Right ventricular hypertrophy
ANS: A
In patients with chronic pulmonary hyperinflation (emphysema), the PMI may be difficult to lo-cate. Because of the increase in anteroposterior diameter and the changes in lung tissue, systolic vibrations are not well transmitted to the chest wall.
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