From the Research
Heaves and thrills are critical physical findings that necessitate immediate further evaluation with echocardiography and other cardiac testing to determine the underlying cause and guide appropriate treatment, as they are indicative of abnormal cardiovascular function, potentially leading to significant morbidity and mortality if left undiagnosed or mismanaged. Heaves are visible or palpable forceful outward movements of the chest wall during cardiac contraction, typically felt at the point of maximal impulse (PMI) and suggesting ventricular enlargement or hypertrophy. Thrills are palpable vibrations felt on the chest wall that resemble the sensation of a purring cat under your hand, representing turbulent blood flow through narrowed or leaky heart valves. These findings are detected by placing the palm or fingertips on specific areas of the chest during examination. Heaves often indicate conditions like left ventricular hypertrophy from hypertension or aortic stenosis, while thrills commonly accompany significant heart valve disorders such as mitral stenosis or ventricular septal defects. No medications directly treat these physical findings, as they are symptoms of underlying cardiac conditions that require specific diagnosis and management. The most recent and highest quality study, 1, emphasizes the role of multimodality cardiac imaging in the diagnosis and management of patients with left ventricular hypertrophy, highlighting the importance of echocardiography as the first-line imaging technique for a comprehensive assessment of LV systolic and diastolic function. Key points to consider in the evaluation of heaves and thrills include:
- The use of echocardiography to assess cardiac chamber size and structure, ventricular function, valvular function, and key haemodynamic parameters, as outlined in 2.
- The importance of differentiating between various "hypertrophic" cardiac phenotypes, as discussed in 3, to guide further confirmatory testing and management.
- The role of stress echocardiography in valvular heart disease, as described in 4, to evaluate asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress.
- The clinical significance of the discrepancy between left ventricular hypertrophy by echocardiography and electrocardiographic hypertrophy, as investigated in 5, to identify patients at higher risk of adverse clinical events. Given the potential for significant morbidity and mortality associated with underlying cardiac conditions, prompt and accurate diagnosis and management of heaves and thrills are crucial to improve patient outcomes and quality of life.