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Cardiovascular Images
October 21, 2020

A Patient in Their 90s With Visible Precordial Pulsations

Author Affiliations
  • 1Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, California
  • 2Lundquist Institute for Biomedical Innovation, Torrance, California
JAMA Cardiol. 2020;5(10):e205107. doi:10.1001/jamacardio.2020.5107

What was the cause of the visible precordial pulsations seen (Figure; Video) in this patient in their 90s who was resuscitated following an out-of-hospital cardiac arrest? On visual inspection, precordial pulsations were clearly and immediately seen over the left chest in the second and third intercostal spaces. Visible precordial pulsations typically originate from either the heart or great vessels. Pulsations over the right precordium suggest pathologies such as aortic dissection or aneurysm, while pulsations over the left precordium suggest right-sided heart pathology, given this structure’s anteriormost location in the chest. In this patient, a transthoracic echocardiogram later revealed a severely dilated right side of the heart, with a pulmonary artery systolic pressure greater than 60 mm Hg as a result of acute pulmonary embolism. This rare clinical finding serves as a reminder that next to palpation, percussion, and auscultation, visual inspection remains an essential component of the chest examination.1,2