Leftsided Causes Of Left Parasternal Movement

1. When is mid- to lower-left parasternal movement due to the LV?

ANS: a. In young subjects with long, thin chests, the LV impulse may be very medial (i.e., at the left parasternal area).

b. In some subjects in whom the LV is markedly enlarged, the movements may extend medially to the left parasternal area (as well as laterally).

c. The movement may occur in the presence of a ventricular aneu-rysm, in which case it will be sustained with a late peak.

2. When is the left parasternal outward movement due to a left atrium? Why?

ANS: In severe chronic mitral regurgitation (MR). The left atrium is a mid-chest structure (i.e., it is not really a left atrium but a posterior atrium). (See figure on p. 100.)

3. How can you tell whether or not an expanding left atrium due to severe chronic MR is the cause of a marked left parasternal movement?

ANS: Compare the LV apical movement with the left parasternal movement by placing a finger on each. A left atrial lift will begin and end slightly later than the LV thrust. Right ventricular movement will begin and end at the same time or even before the LV.

The "left" atrium is really a posterosuperior atrium, since it is behind and above the right atrium. Although it is slightly to the left of the right atrium, it is a midline structure.

The left lower parasternal area movement shows a delayed fall in comparison with the apical impulse in this patient with severe chronic rheumatic MR.

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