Precordial Movements over the Right Ventricle in Normal Children

PHYSICAL diagnosis of the heart has improved considerably as a result of the availability of recording technics that enable the observer to check the physical signs with an instrumental record and thus to educate himself. This technic has been particularly successful in the application of phonocardiography to auscultation, but the analysis of the cardiac impulse by palpation has lagged behind. The information to be gained by palpation was recognized by James Hope' in his classic text of 1839, and the first attempt at recording precordial motion was made by Chauveau and Marey in 1861,2 using a pressure sensitive capsule. Later pioneers in this field include Frank,3 Mackenzie,4 Wiggers,5 and Dressler.6 Renewed interest has followed the development of electronic sensing technics and the opportunity to correlate the record with events observed at cardiac catheterization. A number of investigators7-19 have made important contributions; outstanding among these is the work of Hartman and his colleagues in the Netherlands.20 21 It is hoped that a more scientific analysis and description of precordial motion will result, in place of the "thrust, heave and tap" to be found in most standard textbooks. The authors have studied precordial motion in normal children and, in particular, movements at the sternal border where alterations may be expected in congenital cardiac malformations affecting the right ventricle. Studies were made in the pediatric age group for three reasons: (1) no systematic study of pre-