Initially, palpate with the flat of the hand in the longitudinal direction (craniocaudally) next to the sternum. Follow with the fingertips in the parasternal left (3rd), 4th and 5th intercostal spaces [Figure 8].
Figure 8: Right Ventricular Impulses In The Left Parasternal Region
Establish whether there are impulses and the properties of these impulses (as mentioned in the paragraph above describing the apex beat characteristics). As well as parasternally, right ventricular impulses can frequently be palpated subdiaphragmatically in the epigastrium [Figure 9].
Figure 9: Right Ventricular Impulses In The Epigastrium
In children and young adults, right ventricular impulses can sometimes be found. In other people, they are indicative of right ventricular volume or pressure overload, seen with right ventricular pathology (pulmonary hypertension), but also with severe left ventricular failure.