A site for medical students - Practical,Theory,Osce Notes

Showing posts with label parasternal heave. Show all posts
Showing posts with label parasternal heave. Show all posts

Left Parasternal Heave

It is the systolic elevation of left lower costal cartilages produced by the contraction of hypertrophied and dilated right ventricle.

Method of examination of left parasternal heave
  • Patient is asked to lie supine
  • Stand on the right hand side of the patient
  • Keep the ulnar border of right hand over the 3rd, 4th, 5th left intercostal spaces by the side of the sternum. 
  • Look for any lift of the hand 
  • Systolic elevation of the left lower costal cartilages is felt as an impulse.
Causes  of parasternal heave can be due to right ventriculr or left atrial lift

1.Right ventricular lift
Right ventricular hypertrophy due to:
Pulmonary hypertensions
Pressure overload of RV produce left parasternal heave -seen in sustained impulse as in PAH, Pulmonary stenosis
Volume overload of RV  produce left parasternal lift- forcible impulse as in. ASD and tricuspid regurgitation
Atrial septal defect with or without pulmonary hypertension.
2. Left atrial lift
Left atrial enlargement as in Mitral regurgitation (MR) rarely produces left parasternal lift.
3. Occasionally marked LV enlargement as in Aortic regurgitation (AR) produce counter clockwise rotation of heart so the left parasternal region occupied by the enlarged leftventricle which produce left parasternal lift. Left parasternal impulse is also produced by aneurysm of descending aorta.

Grading of parasternal impulse (AlIMS grading)
  • Grade I   -Visible but not palpable
  • Grade II  -Visible and palpable but obliterable
  • Grade III -Visible and palpable but not obliterable