A parasternal heave is a praecordial impulse that may be palpable in patients with cardiac or respiratory disease. A 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. Normally no impulse or a slight inward impulse is felt. It occurs in the setting of right ventricular enlargement (hypertrophy

Hypertrophy

Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It should be distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number...

) or very rarely severe left atrial enlargement. The heel of the hand is lifted off the chest wall with each systole

Systole (medicine)

Systole is the contraction of the heart. Used alone, it usually means the contraction of the left ventricle.In all mammals, the heart has 4 chambers. The left and right ventricles pump together. The atria and ventricles pump in sequence...

. Palpation with the fingers over the pulmonary area may reveal the palpable tap of pulmonary valve

Pulmonary valve

The pulmonary valve is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. Similar to the aortic valve, the pulmonary valve opens in ventricular systole, when the pressure in the right ventricle rises above the pressure in the...

 closure (palpable P2) in cases of pulmonary hypertension. Hypertrophy of the right side of the heart will occur when the right side of the heart contracts against higher pressure. This occurs in the setting of valvular disease i.e pulmonary valve, and in the setting of respiratory disease where by the pressure in the Pulmonary Artery becomes elevated (for example Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...

. An example of a condition where parasternal heave can be felt is Cor pulmonale

Cor pulmonale

Cor pulmonale or pulmonary heart disease is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs ....

.