The precordial heave associated with mitral-valve lesions, and usually attributed to right-ventricular hypertrophy, is most marked in the left parasternal region. When right-ventricular hypertrophy is due to congenital lesions, the peak forward movement shifts from the neighborhood of the sternum to the left precordial area. It is suggested that in the presence of mitral-valve lesions, enlargement of the left atrium forces the right ventricle toward the sternum and thus significantly influences the development and site of the precordial heave.
Dressler W. Precordial Heave on the Right Related to Left-Atrial Enlargement. JAMA. 1968;205(9):642–643. doi:10.1001/jama.1968.03140350052014
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