Sustained LV/RV impulses: RV etiology?

Sustained LV/RV impulses: RV etiology?

• A. Pulmonary Stenosis and Pulmonary Hypertension; More Forceful and Sustained Throughout
• B. Atrial Septal Defect
• C. Tricuspid Regurgitation
• D. Right Ventricular Infarction

Answer: (A)

A sustained, forceful right ventricular impulse reflects RV hypertrophy from pressure overload. When the RV must pump against high afterload—such as with pulmonary stenosis or pulmonary hypertension—the RV muscle thickens and the impulse at the left lower sternal border becomes not only stronger but longer, often felt as a sustained lift that persists through part of systole. This is a classic sign of RV “working hard” to overcome increased pulmonary resistance. Atrial septal defect tends to cause volume overload of the right heart with a prominent P2 and a displaced, diffuse impulse rather than a clearly sustained RV lift. Tricuspid regurg often presents with a holosystolic murmur and may be associated with RV dilation, but the palpable impulse is not characteristically sustained. Right ventricular infarction can blunt or quiet the precordial impulse and is typically accompanied by hypotension and other signs of ischemia, rather than a sustained RV lift.

A sustained, forceful right ventricular impulse reflects RV hypertrophy from pressure overload. When the RV must pump against high afterload—such as with pulmonary stenosis or pulmonary hypertension—the RV muscle thickens and the impulse at the left lower sternal border becomes not only stronger but longer, often felt as a sustained lift that persists through part of systole. This is a classic sign of RV “working hard” to overcome increased pulmonary resistance.

Atrial septal defect tends to cause volume overload of the right heart with a prominent P2 and a displaced, diffuse impulse rather than a clearly sustained RV lift. Tricuspid regurg often presents with a holosystolic murmur and may be associated with RV dilation, but the palpable impulse is not characteristically sustained. Right ventricular infarction can blunt or quiet the precordial impulse and is typically accompanied by hypotension and other signs of ischemia, rather than a sustained RV lift.