# The patient's apical impulse shows a sustained ______ pattern, suggesting left ventricular hypertrophy.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168426  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

The patient's apical impulse shows a sustained ______ pattern, suggesting left ventricular hypertrophy.

## 보기

1. lifting **✔ 정답**
2. tapping
3. diffuse
4. normal
5. weak

**정답: 1**

## 해설

A sustained lifting pattern of the apical impulse is characteristic of left ventricular hypertrophy. This forceful, prolonged impulse reflects the increased mass and power of the hypertrophied left ventricle during contraction.

## 임상 시나리오

Apical Impulse Assessment:
- Normal apical impulse: Brief, gentle, localized tap
- Location: Left 5th intercostal space, midclavicular line
- Duration: Less than 50% of systole
- Size: Less than 2-3cm in diameter

Left Ventricular Hypertrophy (LVH) Signs:
- Sustained lifting impulse
- Forceful and prolonged
- Laterally displaced
- Increased diameter >3cm
- Heaving quality
- Duration >50% of systole

Clinical Correlation:
- Causes of LVH: Hypertension, aortic stenosis, athletic heart
- Associated findings: S4 gallop, loud S1
- ECG changes: High voltage QRS, ST-T changes
- Diagnostic criteria: Increased left ventricular wall thickness on echo

Differential Patterns:
- Tapping: Normal or right ventricular
- Diffuse: Dilated cardiomyopathy
- Weak: Emphysema, obesity
- Double: Complete heart block

## 핵심 개념

- **lifting** — A forceful, sustained upward movement or heave of the chest wall during cardiac contraction
- **tapping** — A brief, localized, sharp striking sensation felt on the chest wall during cardiac contraction
- **diffuse** — Spread out over a wide area, not localized to a specific point on the chest wall
- **normal** — The typical, physiological pattern of cardiac impulse without any abnormal characteristics
- **weak** — A reduced or diminished force of the cardiac impulse felt on the chest wall

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