All issues > Volume 35(7); 1992

Original Article

J Korean Pediatr Soc. 1992;35(7):942-948. Published online July 15, 1992.

The Left Parasternal Movement in Children with Heart Diseases

Dae Ho DH Choi¹, Byung Hyun BH Kim¹, Hyang Suk HS Yoon¹, Kwang Soo KS Oh¹, Yeon Gyun YG Oh¹, Jong Duck JD Kim¹

¹Department of Pediatrics, Wonkwang University, College of Medicine, IRi, Korea

Abstract

When we are examining a cardiac patient, we want to make a physical diagnosis including involved ventricles, type of overload(volume or pressure), its degree, and the status or degree of pulmonary hypertension. Among various physical examinations of the cardiac patients, a left parasternal movement can give us a status of various degree of the volume and pressure overload of the ventricles. The left parasternal movements were examined by inspection and palpation, and their movements were recorded by polygraph in 40 normal children and in 46 patients with heart diseases. The movements were classified into 5 degrees; N(negative), R(retraction), T&R(tap and retraction), HD(hyperdynamic), SH(sustained heave). And, we compared the datas with 5 groups of heart diseases such as right and left ventricular volume overload, pressure overload, and combined group. The results are described in this paper. The results showed that 35% of normal children aging 2 to 12 years have the minor movement with short and rapid, small rise on early systole, then followed by major retraction. Only a retraction was observed in 45% of all control group. In children with age group of 12 years and over, a T(tap) was not recorded. In a right ventricular volume overload group(n=8), two of young ASD showed negative movement; three of remainder showed HD and SH respectively. But, in a pressure overload group(n=12), SH was recorded in 9 patients(75%). In a left ventricular volume overload group, R and T&R were recorded in 100% of them. In combined group, a movement of the left parasternal edge showed variable, but mafority with severe pulmonary hypertension with L-R shunt disease had a SH. In conclusion, we can diagnose a status of ventricular overload patterns through the physical examination of the left parasternal movements.

Keywords :Physical examination, Left parasternal movement, Ventricular overload