Discovered upon inspection, a pulsation or systolic bulge found at the third intercostal space, left sternal border, is considered
a. normal, caused by blood pulsating against the left ventricular wall.
b. abnormal, possibly caused by a left ventricular aneurysm.
c. abnormal, possibly caused by pericardial disease with constriction.
d. abnormal, possibly caused by a right ventricular rupture.
B
A pulsation or systolic bulge found at the third intercostal space, left sternal border (in the midprecordial area), is considered abnormal. A left ventricular aneurysm can produce a midprecordial pulsation. Ventricular aneurysms can develop several weeks following an acute MI. With an MI, the hydraulic stress on the infarcted area can cause the damaged ventricular wall to bulge and become extremely thin during systole. Pericardial disease can produce retractions in the midprecordial area.
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