Diffuse LV/RV impulses: RV etiology?

Diffuse LV/RV impulses: RV etiology?

• A. Atrial/Septal Defect; Slightly More Forceful With Normal to Sustained Duration
• B. Pulmonary Embolism
• C. Tricuspid Stenosis
• D. Right Ventricular Hypertrophy

Answer: (A)

A diffuse precordial impulse that involves both ventricles points to right heart volume overload, most classically from a left‑to‑right shunt such as an atrial septal defect. In ASD, chronic increased flow to the right ventricle causes dilation and a more widely felt, less localized impulse along the left sternal border. The impulse is slightly more forceful than normal because of the increased stroke volume, but its duration remains normal to mildly sustained, distinguishing it from a thrust associated with left ventricular hypertrophy. Pulmonary embolism and tricuspid stenosis can affect the right heart but do not produce this diffuse impulse pattern, and isolated right ventricular hypertrophy tends to present with a more localized heave rather than a diffuse, slightly forceful impulse.

A diffuse precordial impulse that involves both ventricles points to right heart volume overload, most classically from a left‑to‑right shunt such as an atrial septal defect. In ASD, chronic increased flow to the right ventricle causes dilation and a more widely felt, less localized impulse along the left sternal border. The impulse is slightly more forceful than normal because of the increased stroke volume, but its duration remains normal to mildly sustained, distinguishing it from a thrust associated with left ventricular hypertrophy. Pulmonary embolism and tricuspid stenosis can affect the right heart but do not produce this diffuse impulse pattern, and isolated right ventricular hypertrophy tends to present with a more localized heave rather than a diffuse, slightly forceful impulse.