Wrist and Hand Conditions

Physical Findings
Rapid, jerky upstroke of the carotid pulse
A double or triple apex beat
harsh systolic ejection murmur at the lower
LSB medial to the apex (increases in intensity
with maneuvers that decrease venous return
such as Valsalva’s maneuver or standing and
decreases with squatting, leg raise and
clenching fist).
wide splitting of S2
third heart sound is common, owing to
greater diastolic filling rates
fourth heart sound may be heard as a result
of vigorous atrial contractions in individuals
with thin chest walls.