Before the surgery, a thoracic drain was positioned and fixed by finger-trap suture in the eighth left intercostal space
. Subsequently, a scalpel incision was made in the skin and musculature of the third sternebra till the xiphoid process.
Ejection systolic murmur was heard in the 2nd left intercostal space
. Echocardiography revealed dilated, well-circumscribed, homogeneous mass attached to the right ventricular outflow tract causing mild obstruction.
On cardiac examination, her pulse and S1 and S2 were normal, but she had a grade 2/6 holosystolic murmur at the second left intercostal space
Apex beat was in fifth left intercostal space
just inside midclavicular line, forceful in nature.
Physical examination revealed a regular heart rate at 100 beats/ min, a blood pressure of 111/53 mmHg, a respiratory rate of 19 breaths/min, slight jugular venous distention suggesting a right atrial mean pressure of 8-10 cm of blood, crackles at both lung bases (L>R), a soft systolic murmur in the 2nd left intercostal space
at the sternal edge, 1+/4+ pretibial edema bilaterally, and slight abdominal distention.
Surgical management of ruminal fisula due to traumatic injury by iron rod near to the last left intercostal space
in a cow (Prakash and Ravi, 2009), ruminal fistula along with impaction due to plastic sheets, wires and twisted ropes (Rameshkumar et al., 2000) have been reported.
A Grade IV/VI systolic murmur at the cardiac apex with radiation to left armpit, a Grade IV/VI systolic murmur in the second right intercostal space with radiation to carotid artery, and a diastolic murmur in the third left intercostal space
Her cardiovascular system examination revealed the apex beat to be at the 4th left intercostal space
with tapping character.
On routine physical examination, low-grade continuous murmur, peaking in late systole was heard incidentally in the second left intercostal space
. Then the patient was referred to our clinic for further examination.
There was cardiomegaly with the apex beat in the 5th left intercostal space
, lateral to the mid-clavicular line.
The patient is placed in the same body position as on previous studies (usually supine, semi-recumbent) and the same control site must also be used, over the left intercostal space
, mid-clavicular level.
On exam, he had blowing, decrescendo, grade II/VI diastolic murmur heard best in the third left intercostal space
, and grade III/VI holosystolic murmur on the left sternal border.