The characteristic physical habitus of the patient with Marfan's syndrome often leads to the correct diagnosis. The art of palpation is rapidly disappearing despite the fact that it can yield valuable information. The enlarged, sustained left parasternal impulse of right ventricular dilatation or hypertrophy also can be detected. In normal adults, a right ventricular impulse is not felt. The initial pulsation is a palpable S4 and is associated with abnormal left ventricular early diastolic function that is usually present in patients with left ventricular hypertrophy, reduced ejection fraction, or myocardial ischemia.
Heart sounds and murmurs are also palpable, particularly if they are loud.
A palpable systolic thrill along the upper right sternal border can often be felt in patients with clinically significant aortic stenosis. To determine whether an event such as a thrill is systolic in timing, it is often necessary to palpate the carotid pulse simultaneously. A careful assessment of peripheral arterial pulses should be performed in patients with suspected cardiovascular disease. The examiner should also note the size as well as the thickness and hardness of the vessel wall and any evidence of nodularity, tenderness, or tortuosity. The best way to detect right ventricular failure is by examining the jugular venous pulse.