A parasternal heave, lift, or thrust is a
precordial impulse that may be felt (palpated) in patients with cardiac or respiratory disease. Precordial impulses are visible or palpable pulsations of the chest wall, which originate on the heart or the
great vessels
Great vessels are the large vessels that bring blood to and from the heart. These are:
* Superior vena cava
*Inferior vena cava
* Pulmonary arteries
* Pulmonary veins
*Aorta
Transposition of the great vessels is a group of congenital heart de ...
.
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Technique
A parasternal impulse may be felt when the heel of the hand is rested just to the left of the
sternum
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. ...
with the fingers lifted slightly off the chest. Normally no impulse or a slight inward impulse is felt. The heel of the hand is lifted off the chest wall with each
systole. Palpation with the fingers over the pulmonary area may reveal the palpable tap of
pulmonary valve closure (palpable P2) in cases of
pulmonary hypertension.
Interpretation
Parasternal heave occurs during
right ventricular hypertrophy (i.e. enlargement) or very rarely severe left atrial enlargement. This is due to the position of the heart within the chest: the right ventricle is most anterior (closest to the chest wall). Hypertrophy of the right side of the heart will occur when the right side of the heart chronically contracts against higher pressure. This occurs in the setting of valvular disease i.e.
pulmonary valve, and in the setting of respiratory disease whereby the pressure in the
pulmonary artery
A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and ...
becomes elevated (e.g.,
chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
). An example of a condition where parasternal heave can be felt is
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