Sustained LV/RV impulses: LV etiology?

Sustained LV/RV impulses: LV etiology?

• A. LV: Aortic Stenosis and Hypertension; Sustained Tapping Through S2
• B. LV: Mitral Stenosis; Short Duration
• C. LV: Atrial Septal Defect; No Duration
• D. LV: Pulmonary Embolism; Pulsatile Rhythm

Answer: (A)

A sustained apical impulse that can be felt through the second heart sound indicates left ventricular hypertrophy from increased afterload. This is classically seen with conditions that chronically raise the LV workload, such as aortic stenosis and systemic hypertension, where the LV enlarges and the impulse remains strong and prominent through S2. Mitral stenosis tends to affect the left atrium and diastolic dynamics, not producing a sustained LV impulse through S2. An atrial septal defect causes RV volume overload and shifts the focus to the right side, with a different auscultatory pattern rather than a sustained LV apical impulse. Pulmonary embolism acutely strains the right ventricle, again not presenting as a sustained LV impulse at the apex.

A sustained apical impulse that can be felt through the second heart sound indicates left ventricular hypertrophy from increased afterload. This is classically seen with conditions that chronically raise the LV workload, such as aortic stenosis and systemic hypertension, where the LV enlarges and the impulse remains strong and prominent through S2.

Mitral stenosis tends to affect the left atrium and diastolic dynamics, not producing a sustained LV impulse through S2. An atrial septal defect causes RV volume overload and shifts the focus to the right side, with a different auscultatory pattern rather than a sustained LV apical impulse. Pulmonary embolism acutely strains the right ventricle, again not presenting as a sustained LV impulse at the apex.