Correspondence

Post-it Apexcardiography

N Engl J Med 2004; 351:1364September 23, 2004

Article

To the Editor:

I wish to report yet one more use for the ubiquitous Post-it, this time as an aid in cardiac physical diagnosis. The adhesive on Post-it notes consists of tiny spheres that are sticky individually. Because these spheres make only intermittent contact with an object, they do not stick strongly and can temporarily adhere to the skin. A small Post-it folded into an L-shaped strip readily clings to the skin during a physical examination. The free edge of the folded paper, oriented like a flag, perpendicular to the surface of the skin, greatly amplifies cardiac, arterial, and jugular venous pulsations. When the folded strip of adhesive paper is properly placed on the point of the maximal impulse of the heart, the subjective tactile perception of a single observer is replaced by a visual demonstration of the cardiac impulse. This technique, unlike palpation, permits the cardiac impulse to be simultaneously evaluated by multiple observers.

In the course of teaching bedside cardiac physical diagnosis, my colleagues and I have found this technique to be expeditious, successful, and surprisingly well received by medical students, residents, and patients. Because it is most useful for visualizing multiple rapid cardiovascular vibrations, the technique is well suited to illustrating the contour of the carotid pulse and to facilitating the inspection and understanding of jugular venous pulsations.1 Even the experienced examiner finds it useful for the demonstration of the apical “triple ripple” of hypertrophic obstructive cardiomyopathy, for distinguishing a bisferiens from a dicrotic arterial pulse, and for enhancing the visibility of venous pulsations in the neck.

Daniel Shindler, M.D.
University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ 08901
shindler@umdnj.edu

1 References