Diffuse LV/RV impulses: LV etiology?

Diffuse LV/RV impulses: LV etiology?

• A. AV/MV Regurgitation and Cardiomyopathy; 3 cm Enlarged; 4 cm Overload
• B. Pulmonary Hypertension
• C. Aortic Stenosis
• D. Mitral Valve Prolapse

Answer: (A)

Diffuse precordial impulses signal that the ventricle is enlarged or remodelled, so the impulse is felt over a wider area rather than as a single, sharp tap. This most often comes from left ventricular volume or size overload. When AV or MV regurgitation occurs, the LV receives excess volume each heartbeat, leading to dilation and a broader, sometimes displaced apical impulse. Primary cardiomyopathy, whether dilated or hypertrophic, can do the same by enlarging or thickening the LV, producing a diffuse impulse as well. So the LV-side causes—valvular regurgitation with cardiomyopathy—best explain diffuse LV/RV impulses. In contrast, pulmonary hypertension tends to heighten the right ventricular impulse, aortic stenosis produces a more localized, possibly sustained apical impulse, and mitral valve prolapse is typically associated with a midsystolic click rather than a diffuse LV impulse.

Diffuse precordial impulses signal that the ventricle is enlarged or remodelled, so the impulse is felt over a wider area rather than as a single, sharp tap. This most often comes from left ventricular volume or size overload. When AV or MV regurgitation occurs, the LV receives excess volume each heartbeat, leading to dilation and a broader, sometimes displaced apical impulse. Primary cardiomyopathy, whether dilated or hypertrophic, can do the same by enlarging or thickening the LV, producing a diffuse impulse as well. So the LV-side causes—valvular regurgitation with cardiomyopathy—best explain diffuse LV/RV impulses.

In contrast, pulmonary hypertension tends to heighten the right ventricular impulse, aortic stenosis produces a more localized, possibly sustained apical impulse, and mitral valve prolapse is typically associated with a midsystolic click rather than a diffuse LV impulse.