THE CLINICAL SIGNIFICANCE OF SYSTOLIC RETRACTION OF THE APICAL IMPULSE

Abstract

The clinical significance of systolic retraction of the apical impulse has been investigated, using the impulse recorder described by Beilin and Mounsey (1962). Eight healthy subjects and 26 patients were included in the study. Slight apical retraction in later systole occurred in health, with the subject lying prone at 45[degree]. Marked apical systolic retraction occurs in 2 forms of heart disease. In con-strictive pericarditis of the localized annual type, widespread retraction of the whole precordium, including the apex beat, was seen. In the more generalized form of constrictive pericarditis, however, this sign was absent. The second cardiac lesion in which apical systolic retraction occurred was tricuspid incompetence most commonly due to rheumatic heart disease, but in 2 cases to cardiomyopathy. Apical retraction did not occur in tricuspid incompetence, if the left ventricle was hyper-trophied. Retraction was most vigorous with free tricuspid incompetence and giant right heart enlargement: in an exceptional case-side-to-side rocking of the whole thorax was noted. In contradistinction to the widespread precordial retraction of constrictive pericarditis, in tricuspid incompetence only the apical area retracted. A rare cause of precordial systolic retraction is pleuropericardial adhesions, in the absence of heart disease. The genesis of apical systolic retraction is discussed.