A parasternal heave, lift, or thrust is a

precordial In anatomy, the precordium or praecordium is the portion of the body over the heart and lower chest.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 defec ...

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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. Sh ...

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 Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun ...

. Palpation with the fingers over the pulmonary area may reveal the palpable tap of

pulmonary valve The pulmonary valve (sometimes referred to as the pulmonic valve) is a valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. It is one of the four valves of the heart and one of the two semilunar v ...

closure (palpable P2) in cases of pulmonary hypertension.

Interpretation

Parasternal heave occurs during

right ventricular hypertrophy Right ventricular hypertrophy (RVH) is a condition defined by an abnormal enlargement of the cardiac muscle surrounding the right ventricle. The right ventricle is one of the four chambers of the heart. It is located towards the lower-end of the h ...

(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.

, 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 t ...

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

cor pulmonale Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chroni ...

. This impulse may also be felt in dilated right ventricular myopathy. The palpation of dilated myopathy differs in that the impulse tends to be vigorous and brief. This is in contrast with the sustained impulse of the hypertrophied right ventricle. A parasternal heave may also be felt in

mitral stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...

. A left ventricular heave (or lift) suggests the possibility of

aortic stenosis Aortic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse ov ...

References

Symptoms and signs: Cardiac {{circulatory-stub