True regarding left parasternal lift

Ans. d (All of the above) (Ref. H - 18th/ch. 227)Right ventricular hypertrophy often results in a sustained systolic lift at the lower left parasternal area, which starts in early systole and is synchronous with the left ventricular apical impulse.LEFT PARASTERNAL LIFT/HEAVE# The left ventricular apex beat may be visible in the midclavicular line at the fifth intercostal space in thin- chested adults. Visible pulsations anywhere other than this expected location are abnormal. The left anterior chest wall may heave in patients with an enlarged or hyperdynamic left or right ventricle.# Physical examination in patients with pulmonary arterial hypertension shows tachypnea, a prominent pulmonic S2 heart sound, palpable right ventricular heave, elevated jugular venous pressure, and dependent edema.# Many of the signs encountered in cor pulmonale are also present in HF patients with a depressed EF, including tachypnea, elevated jugular venous pressures, hepatomegaly, and lower-extremity edema. Patients may have prominent v waves in the jugular venous pulse as a result of tricuspid regurgitation. Other cardiovascular signs include an RV heave palpable along the left sternal border or in the epigastrium. The increase in intensity of the holosystolic murmur of tricuspid regurgitation with inspiration ("Carvallo's sign") may be lost eventually as RV failure worsens. Cyanosis is a late finding in cor pulmonale and is secondary to a low cardiac output with systemic vasoconstriction and ventilation-perfusion mismatches in the lung.