Portal de Periódicos da CAPES

THE LEFT PARASTERNAL IMPULSE

1964; BMJ; Volume: 26; Issue: 6 Linguagem: Inglês

10.1136/hrt.26.6.726

1468-201X

P. M. S. Gillam, A. A. Deliyannis, J. P. D. Mounsey,

A lift or heave which is palpable at the left sternal edge is an accepted clinical sign of right ventricular hypertrophy.The parasternal impulse has been recorded in normal subjects and in patients with heart disease, and the results are described in this paper.A detailed description of the instrument used to make the recordings has already been published (Beilin and Mounsey, 1962).This instrument records absolute displacement of a selected area on the chest wall.By correlating the recordings with clinical examination, chest radiographs, electrocardiograms, and the results of right heart catheterization, we have been able to define, in terms of displacement, the characteristics that distinguish normal from abnormal impulses.We have also attempted to assess the reliability of an abnormal impulse in revealing underlying ventricular and atrial hypertrophy. SUBJECTS AND METHODSThe impulse cardiogram was recorded with the patient lying on a couch in the semi-recumbent position, with the breath held in expiration.The recording instrument consists essentially of a brass rod with a small button 3 mm. in diameter at one end, which is placed on the chest wall and moved up and down by the cardiac impulse.Movement of the rod interrupts a beam of light on a photoelectric cell: this varies the resistance in an electrical circuit, the current from which is fed into the extra low frequency galvanometer of a Cambridge phonocardiograph.The recording system was arranged so that 1 mm. of movement of the chest wall pro- duced a 5 cm.deflection in the impulse cardiogram.A simultaneous electrocardiogram and phonocardio- gram were recorded as reference tracings.The left parasternal impulse was recorded at the site of greatest pulsation.In some patients this was in the third or fourth intercostal space; in others the fourth, fifth, and sixth costal cartilages were so close together that the knob of the recorder was placed on top of them.The exact site of the left parasternal impulse was recorded in each case.The apical impulse was also recorded routinely in all cases.Twenty normal subjects and 71 patients with heart disease were studied.Of the 20 normal subjects, 6 were volunteers from among the medical staff, and 14 were patients with clinically normal hearts.There were 14 males and 6 females, 3 of whom were children; their ages varied from 5 to 52 years.Of the 71 patients, 9 had pulmonary stenosis, 4 had Fallot's tetralogy, 8 had atrial septal defect, 15 had ventricular septal defect, and 1 had a patent ductus arteriosus; 8 patients had mitral stenosis and 14 mitral incompetence; 1 had primary pulmonary hypertension, and 1 pulmonary hypertension resulting from chronic bronchitis and emphysema; 10 patients were suffering from cardiomyopathy.There were 28 males and 43 females, 12 of whom were children; their ages varied from 5 to 70 years.In all patients a full 14-lead electrocardiogram, and postero- anterior and lateral chest radiographs were used for the assessment of right ventricular hypertrophy.The electrocardiographic criteria employed were those of Goodwin and Abdin (1959).Confirmation of the diagnosis was obtained in 61 of the patients by cardiac catheterization.Angiocardiograms were available in 42 of the cases.