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December 1973

Quantitative Grading of Cardiac Palpation: Comparison in Supine and Left Lateral Decubitus Positions

Author Affiliations


From the Department of Medicine, University of Pennsylvania, and the Hospital of the University of Pennsylvania, Philadelphia. Dr. Mills is now at the Peter Bent Brigham Hospital in Boston.

Arch Intern Med. 1973;132(6):831-834. doi:10.1001/archinte.1973.03650120039007

One hundred thirty-three subjects were examined by means of a new quantitative system for classifying cardiac apical impulse; findings in the supine and the left lateral decubitus (LLD) positions were compared. Impulses were designated physiologic, sustained, or hyperkinetic. Thirty-five of 38 normal subjects (92%) had physiologic impulses in LLD position; 26 of 29 (90%) with heart disease and left ventricular dysfunction had abnormal impulses. Four of five with regurgitant valvular disease had hyperkinetic impulses. Seven of ten with diastolic hypertension and nine of ten with outflow obstruction or dyskinesia had sustained impulses. In subjects over 30 years old, examination in LLD position doubled the incidence of palpable apical impulses.

Quantitative grading of apical impulse in the LLD position generates a classification that correlates well with left ventricular hemodynamics. Findings are consistent with associations established by recording precordial movement.