The Parsternal Impulse

ABSTRACT

The left parasternal impulse was evaluated by inspection and palpation, and it's contour was confirmed with graphic display using a pilse pickup in 45 normal subjects and 33 patients with various cardiac disease.Using an upper limit of normal echocardiographic LV end-diastolic dimension insides, 3.7cm/m2, LV mass index, 80g/m2, RV dimension index, 2.9cm/m2, and RV free wall thickness, 0.4cm, the patients were subdivided into four groups. In 9 patients with pure RV hypertrophy or dilation, the hyperdynamic impulse or sustained heave was noticed in 7 cases(sensitivity 78%, specificity 76%). In 12 patients with pure LV hypertrophy or dilation, striking parasternal systolic retraction was noticed in 5 cases(sensitivity 42%, speccificity 86%). But in 7 patient with biventricular hypertrophy or dilation, either striking systolic retraction or hyperdynamic impulse was noticed in 4 cases. These findings suggest that the evaluation of the parasternal movement is helpful for the cardiac examination.