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Examination of the Heart Examination of the heart is performed with the patient lying supine and the upper body undressed. Begin with a general inspection which can reveal signs of cardiac illnesses. For example, a thoracotomy scar can indicate a history of cardiac surgery and distended neck veins can be a sign of heart failure or Superior Vena Cava Syndrome. Palpation of the apex heart beat is best performed with the patient lying on the left side. To feel the beat, place your hand on the thorax in the area of the cardiac apex. Note that it is not always palpable. Normally, the beat should be felt on the midclavicular line of the fifth intercostal space -- or ICS -- of the left hemithorax. If cardiac dilatation is present, the apex beat is widened and displaced caudally and laterally. Auscultation is a key technique to assess the cardiac rhythm and possible cardiac disorders. You can facilitate auscultation by asking the patient to hold the breath after exhaling. This reduces the dam