From the Guidelines
Heaves and thrills are critical physical examination findings that indicate abnormal cardiovascular function, with heaves suggesting ventricular enlargement or hypertrophy and thrills representing turbulent blood flow through narrowed or leaky heart valves. Heaves are typically felt at the point of maximal impulse (PMI) and can be associated with conditions such as left ventricular hypertrophy from hypertension or aortic stenosis, as seen in patients with valvular heart disease 1. Thrills, on the other hand, are palpable vibrations that resemble the sensation of a purring cat under your hand and are commonly accompanied by significant heart murmurs in conditions such as aortic stenosis, mitral regurgitation, or ventricular septal defects. Some key factors that differentiate the various causes of left ventricular outflow tract obstruction, including heaves and thrills, are outlined in Table 3 of the acc/aha 2006 guidelines for the management of patients with valvular heart disease 1, which highlights the importance of careful physical examination and further diagnostic testing, such as echocardiography, to determine the underlying cause and severity of the cardiac abnormality. The detection of heaves and thrills during physical examination warrants a more aggressive diagnostic approach, including echocardiography to rule in or rule out significant valvular disease, as these findings can be indicative of underlying conditions that require prompt medical attention 1. In patients with cardiac murmurs and clinical findings suggestive of endocarditis, echocardiography is also indicated, further emphasizing the importance of thorough evaluation in the presence of heaves and thrills 1. Overall, the presence of heaves and thrills should prompt a thorough cardiac evaluation to determine the underlying cause and guide appropriate management.
From the Research
Definition of Heaves and Thrills
- Heaves and thrills are terms used to describe abnormal heart sounds or vibrations that can be felt on the chest wall.
- Heaves refer to a lifting or bulging of the chest wall, often associated with an abnormal heart rhythm or condition.
- Thrills, on the other hand, are vibrations that can be felt on the chest wall, typically associated with turbulent blood flow or abnormal heart valve function.
Clinical Significance
- Heaves and thrills can be indicative of underlying heart conditions, such as valvular heart disease, heart failure, or left ventricular hypertrophy 2, 3.
- The presence of heaves and thrills can be an important diagnostic clue, and further evaluation using imaging modalities such as echocardiography, cardiovascular magnetic resonance, or cardiac CT may be necessary to determine the underlying cause 2, 4, 3.
Diagnostic Evaluation
- Echocardiography is a commonly used imaging modality to evaluate heart function and structure, and can help identify the cause of heaves and thrills 2, 5, 4, 3.
- Stress echocardiography may also be used to evaluate valve function and left ventricular function under stress, which can help identify patients with valvular heart disease or left ventricular hypertrophy who may benefit from further treatment 4.
- Multimodality cardiac imaging, including echocardiography, cardiovascular magnetic resonance, and cardiac CT, can provide a comprehensive assessment of heart function and structure, and can help guide treatment decisions 2, 3.