Parasternal heave is the forward movement of the lower left parasternal area that can be seen and felt during chest examination. It is graded on a scale of 1 to 3 based on whether the movement is visible only, visible and palpable but disappears with pressure, or visible, palpable and does not disappear with pressure. A parasternal heave indicates enlargement of the right ventricle or left atrium, which can be caused by conditions such as an atrial septal defect or pulmonary hypertension.

1. ‫الرحیم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. PARASTERNAL HEAVE
Significance and Grades

3. PARASTERNAL HEAVE
• Indicates forward (anterior) movement of lower left parasternal area.
• Palpated with the base or ulnar aspect of hand.
• Three grades.
• Grade 1: Visible impulse but not palpable.
• Grade 2: Visible and palpable but obliterable with pressure.
• Grade 3: Visible and palpable but not obliterable with pressure.
• Seen in right ventricular enlargement (as in atrial septal defect,
ventricular septal defect, pulmonic stenosis, pulmonary hypertension)
and left atrial enlargement.