What is a cardiac heave?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 19, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Cardiac Heave: Definition

A cardiac heave is a palpable, sustained, forceful lifting impulse felt on the chest wall during physical examination, indicating underlying ventricular hypertrophy or enlargement.

Physical Examination Finding

A cardiac heave represents a palpable left parasternal lift produced by the impulse of a hypertrophied, high-pressure ventricle pressing against the chest wall 1. This is distinct from a normal apical impulse, which is typically brief and localized.

Right Ventricular Heave

When right ventricular hypertrophy is present, the resulting hypertrophy produces an RV heave that is palpable along the left parasternal border 2. This sustained lifting sensation occurs because the enlarged right ventricle contracts forcefully against the sternum during systole.

Key characteristics include:

  • Location: Left parasternal border (along the sternum)
  • Quality: Sustained, lifting impulse (not just a tap)
  • Timing: Occurs during systole
  • Associated findings: Often accompanied by other signs of ventricular hypertrophy such as a harsh systolic murmur that increases with inspiration, and may be accompanied by a palpable thrill 2

Clinical Significance

The presence of a cardiac heave indicates significant ventricular hypertrophy, most commonly:

  • Right ventricular hypertrophy from pulmonary hypertension, congenital heart disease, or pulmonary valve stenosis 1, 2
  • Left ventricular hypertrophy (produces a prominent apical point of maximal impulse rather than parasternal heave) 3

Examination Technique

To detect a heave:

  • Place the palm of your hand flat against the left sternal border
  • Feel for a sustained, lifting impulse during systole
  • The sensation should be strong enough to lift your hand off the chest wall
  • Compare to the normal brief tapping impulse of a healthy heart

Common pitfall: Do not confuse a heave with a normal apical impulse or a brief tap. A true heave is sustained throughout systole and forceful enough to be unmistakable when present.

References

Related Questions

In a 9‑week‑old infant with subfebrile temperature (maximum 37.8 °C), rhinorrhea, cough, a single post‑cough vomiting episode, inconsolable crying with transient abdominal tenderness that resolves when the infant stops crying, and normal stooling, what is the best management approach?
After percutaneous coronary catheterisation (PCCC), how is the arterial puncture closed?
What is the appropriate treatment for a 25‑year‑old woman with malodorous leukorrhea?
What is the appropriate workup and treatment for a 75-year-old woman with acute swollen fingers limiting movement?
Are there lymph nodes located on the flank above the hip?
What is the appropriate evaluation and management for an asymptomatic right-sided cardiac heave in a 5-year-old child?
In a patient with dense left optic neuropathy, normal ocular motility, and no anisocoria in darkness, which finding is most expected?
In a 67-year-old patient with equal pupils that constrict briskly to light and demonstrate an appropriate near response, which cranial nerve carries the afferent limb of the pupillary light reflex?
In a patient with diplopia and impaired abduction of the right eye, most evident when looking to the right, which extraocular muscle is primarily affected?
In a 29-year-old patient with vertical diplopia that worsens when reading and descending stairs, and a right eye hypertropia that increases on left gaze and with right head tilt, what is the most likely diagnosis?
Which cranial nerve is involved in a patient presenting with acute diplopia, ptosis, a right eye deviated down and out, and a 7 mm poorly reactive pupil?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.