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Glossary of cardiologic terms related to physical diagnosis and history
Committee Report Glossary
of Cardiologic
Physical
Terms
Diagnosis
Related
to
and History
Committee on Standardized Terminology of the American College of Cardiology and the American Heart Association
Part III.
Anterior
The Ventricles,
Chest Movements:
the Atria and the Great Vessels* Committee Members ALVAN R. FEINSTEIN, M.D., New Haven ELLIOT HOCHSTEIN, M.D., New York ALDO A. LUISADA, M.D., F.A.c.c., Chicago JOSEPH K. PERLOFF, M.D., F..~.c.c., Washington, D.C. STUART ROSNER, M.D., Stony Brook, New York ROBERT C. SCHLANT, M.D., F.A.c.c., Atlanta BERNARD L. SEGAL, M.D., F.A.c.c., Philadelphia ALFRED SOFFER, M.D., F.A.c.c., Chicago
single or double. Diastolic movements of the left ventricle occur in mid-diastole or late diastole (presystole). Mid-d iastolic movement is related to the rapid filling phase; late diastolic movement is related to presystolic ventricular filling associated with left atria1 contraction. Left Parasternal Impulses: These impulses should be subdivided according to their locations along the upper, mid, or lower left sternal border. A. Upper left parasternal impulse. An upper left parasternal impulse, especially in the second left intercostal space, is usually due to systolic expansion of a dilated main pulmonary artery. In some normal individuals, especially those with diminished anteroposterior chest dimensions, a normal main pulmonary artery can cause a systolic impulse. B. Mid to lower leftparasternal impulse. A mid to
The anterior chest movements discussed here relate to the situs solitus heart without ventricular inversion or transposition of the great vessels. Apex Impulse: The apex impulse is usually caused by left ventricular contraction which is characterized by a relatively localized outward movement beginning synchronously with the first heart sound. A zone of retraction occurs medial to and simultaneous with the outward movement. Both the outward movement and the simultaneous medial retraction are best delineated when the subject turns toward the left side. When the apex impulse is attributed to the left ventricle, the outward (systolic) mouement should be further characterized according to its location (interspace and distance from the midline), force, duration, rate of anterior displacement, and according to whether it is
* The first two parts in this continuing series of glossaries appeared in the American Jourml of Cardiolog), 20:286, 1967(Part I) and 21: 273,1968(Part II). Address for reprints: William D. Nelligan, Executive Director, The American College of Cardiology, 9650 Rockville Pike, Rockville, Md. 20014. 444
THE
AMERICAN
JOURNAL
OF CARDIOLOGY
Glossary
of Cardiologic
lower left parasternal impulse is usually caused by right ventricular contraction which is characterized by an outward movement beginning synchronously with the first heart sound. A zone of retraction can sometimes be identified lateral to and simultaneous with the outward Iuovemcnt. At times the outward parasternal Irlovement extends to the cardiac apex; under these circumstances, the apex mo\-ement is caused by the right rather than the left ventricle. \Vhen a left parasternal impulse is attributed to the right \-entricle, the outward (systolic) movement should be further characterized according to its force, duration and rate of anterior displacement. Diastolic movements of the right ventricle occur in mid-diastole or late diastole (presystole). Mid-diastolic movement is related to the rapid filling phase; late diastolic movement is related to presystolic ventricular filling associated with right atria1 contraction. A mid to lower left parasternal impulse can occur with mitral incompetence. As the left atrium receives the regurgitant flow, the right ventricle tends to be displaced forward, causing a parasternal impulse. This impulse is slightly delayed relative to the usual right ventricular impulse, occurring at a perceptible interval after the first heart sound. Right Parasternal Impulses: These impulses should be subdivided according to their loca-
VOLUME
24,
SEPTEMBER
1769
Terms
145
tions along the upper, mid, or louver right sternal border. 9. C@er right parasternal im#ulse. A4~1 upper right parasternal impulse, especially in the first intercostal space or near the sternoclavicular junction, is usually due to dilatation of the underlying aorta or brachiocephalic (innominate) artery or to systolic expansion of a right aortic arch. An upper right parasternal impulse in the second or third intercostal space is usually due to a dilated ascending aorta. B. Mid to lower right parasternal impulse. An impulse along the mid to lower right sternal border is sometimes caused by systolic expansion of an enlarged right atrium (tricuspid regurgitation) or, less commonly, by powerful contraction of a dilated right atrium. Subxyphoid Impulse: The systolic impulse of an enlarged or hypertrophied right ventricle can often be detected against the diaphragm in the subxyphoid region, especially during held inspiration. Ectopic Impulses: Ectopic impulses are located at sites removed from those that would be expected on the basis of the anatomy of the heart and great vessels. For example, an aneurysm of the left ventricle may cause an ectopic impulse that is considerably superior to the cardiac of the left atrium is apex, . massive dilatation occasionally responsible for ectopic impulses in the right. or left lateral chest.
of Cardiologic
Physical
Terms
Diagnosis
Related
to
and History
Committee on Standardized Terminology of the American College of Cardiology and the American Heart Association
Part III.
Anterior
The Ventricles,
Chest Movements:
the Atria and the Great Vessels* Committee Members ALVAN R. FEINSTEIN, M.D., New Haven ELLIOT HOCHSTEIN, M.D., New York ALDO A. LUISADA, M.D., F.A.c.c., Chicago JOSEPH K. PERLOFF, M.D., F..~.c.c., Washington, D.C. STUART ROSNER, M.D., Stony Brook, New York ROBERT C. SCHLANT, M.D., F.A.c.c., Atlanta BERNARD L. SEGAL, M.D., F.A.c.c., Philadelphia ALFRED SOFFER, M.D., F.A.c.c., Chicago
single or double. Diastolic movements of the left ventricle occur in mid-diastole or late diastole (presystole). Mid-d iastolic movement is related to the rapid filling phase; late diastolic movement is related to presystolic ventricular filling associated with left atria1 contraction. Left Parasternal Impulses: These impulses should be subdivided according to their locations along the upper, mid, or lower left sternal border. A. Upper left parasternal impulse. An upper left parasternal impulse, especially in the second left intercostal space, is usually due to systolic expansion of a dilated main pulmonary artery. In some normal individuals, especially those with diminished anteroposterior chest dimensions, a normal main pulmonary artery can cause a systolic impulse. B. Mid to lower leftparasternal impulse. A mid to
The anterior chest movements discussed here relate to the situs solitus heart without ventricular inversion or transposition of the great vessels. Apex Impulse: The apex impulse is usually caused by left ventricular contraction which is characterized by a relatively localized outward movement beginning synchronously with the first heart sound. A zone of retraction occurs medial to and simultaneous with the outward movement. Both the outward movement and the simultaneous medial retraction are best delineated when the subject turns toward the left side. When the apex impulse is attributed to the left ventricle, the outward (systolic) mouement should be further characterized according to its location (interspace and distance from the midline), force, duration, rate of anterior displacement, and according to whether it is
* The first two parts in this continuing series of glossaries appeared in the American Jourml of Cardiolog), 20:286, 1967(Part I) and 21: 273,1968(Part II). Address for reprints: William D. Nelligan, Executive Director, The American College of Cardiology, 9650 Rockville Pike, Rockville, Md. 20014. 444
THE
AMERICAN
JOURNAL
OF CARDIOLOGY
Glossary
of Cardiologic
lower left parasternal impulse is usually caused by right ventricular contraction which is characterized by an outward movement beginning synchronously with the first heart sound. A zone of retraction can sometimes be identified lateral to and simultaneous with the outward Iuovemcnt. At times the outward parasternal Irlovement extends to the cardiac apex; under these circumstances, the apex mo\-ement is caused by the right rather than the left ventricle. \Vhen a left parasternal impulse is attributed to the right \-entricle, the outward (systolic) movement should be further characterized according to its force, duration and rate of anterior displacement. Diastolic movements of the right ventricle occur in mid-diastole or late diastole (presystole). Mid-diastolic movement is related to the rapid filling phase; late diastolic movement is related to presystolic ventricular filling associated with right atria1 contraction. A mid to lower left parasternal impulse can occur with mitral incompetence. As the left atrium receives the regurgitant flow, the right ventricle tends to be displaced forward, causing a parasternal impulse. This impulse is slightly delayed relative to the usual right ventricular impulse, occurring at a perceptible interval after the first heart sound. Right Parasternal Impulses: These impulses should be subdivided according to their loca-
VOLUME
24,
SEPTEMBER
1769
Terms
145
tions along the upper, mid, or louver right sternal border. 9. C@er right parasternal im#ulse. A4~1 upper right parasternal impulse, especially in the first intercostal space or near the sternoclavicular junction, is usually due to dilatation of the underlying aorta or brachiocephalic (innominate) artery or to systolic expansion of a right aortic arch. An upper right parasternal impulse in the second or third intercostal space is usually due to a dilated ascending aorta. B. Mid to lower right parasternal impulse. An impulse along the mid to lower right sternal border is sometimes caused by systolic expansion of an enlarged right atrium (tricuspid regurgitation) or, less commonly, by powerful contraction of a dilated right atrium. Subxyphoid Impulse: The systolic impulse of an enlarged or hypertrophied right ventricle can often be detected against the diaphragm in the subxyphoid region, especially during held inspiration. Ectopic Impulses: Ectopic impulses are located at sites removed from those that would be expected on the basis of the anatomy of the heart and great vessels. For example, an aneurysm of the left ventricle may cause an ectopic impulse that is considerably superior to the cardiac of the left atrium is apex, . massive dilatation occasionally responsible for ectopic impulses in the right. or left lateral chest.