Right ventricular impulses and retractions can be observed in the left parasternal region (next to the sternum) at the height of the 4th and 5th intercostal space, and sometimes in the epigastrium as well. In children and young adults the right ventricle pulsations are still physiological. In elderly people they are indicative of right ventricular pressure overload (e.g. as a consequence of a large pulmonary embolism, emphysema or mitral stenosis) or right ventricular volume overload (e.g. as a consequence of tricuspid insufficiency).
