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Parasternal Heave

seen in

  • RV hypertrophy

  • mitral stenosis (left atrial enlargement - rare)

  • respiratory disease (eg COPD)

  • Precordial impulses are visible or palpable pulsations of the chest wall, which originate from the heart or the great vessels

  • parasternal impulse may be felt when the heel of the hand is rested just to the left of the sternum with the fingers lifted slightly off the chest wall with each systole

  • Normally no impulse or a slight inward impulse is felt

  • Palpation with the fingers over the pulmonary area may reveal the palpable tap of pulmonary valve closure (palpable P2) in cases of pulmonary hypertension

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Aortic Rgurgitation

  • Austin-Flint murmur: diastolic rumble at apex when regurgitant jet renders partial closure of the anterior mitral leaflet

  • Becker sign - retinal artery systolic pulsations

  • Corrigan pulse ("water-hammer" pulse) - Abrupt distention/quick collapse on palpation of the peripheral arterial pulse

  • de Musset sign - Bobbing motion of the patient's head with each heartbeat

  • Duroziez sign - Systolic murmur over the femoral artery with proximal compression of the artery, and diastolic murmur over the femoral artery with distal compression of the artery

  • Gerhardt's sign (aka Sailer's sign): Pulsation of the spleen (with splenomegaly)

  • Hill sign - Popliteal cuff systolic blood pressure 40 mm Hg higher than brachial cuff systolic blood pressure

  • Landolfi's sign: Systolic contraction and diastolic dilation of the pupil

  • Lincoln sign

  • Mayne's sign:  drop of at least 15 mmHg in the diastolic blood pressure on raising the arm

  • Müller sign - Visible systolic pulsations of the uvula

  • Quincke sign - Visible pulsations of the fingernail bed with light compression of the fingernail

  • Rosenbach's sign: Hepatic pulsations

  • Shelly's sign: Pulsation of the cervix

  • Sherman sign

  • Traube sign ("pistol-shot" pulse) - Booming systolic and diastolic sounds auscultated over the femoral artery

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