The Heart in Sternal Depression

Abstract

The place where the apex beat appears on the chest wall depends as much on the symmetry of the thorax as on the size of the heart. A change in the alignment of the spine, the posterior fulcrum of the thoracic cage, in the form of scoliosis, alters the position of the beat. Local deformity of the ribs which form the walls of the cage will do the same thing. Deformity of the sternum, the anterior fulcrum of the thorax, as a cause of displacement of the apex beat has received less attention. The effects of depression of the sternum (pectus excavatum) on the shape and position of the heart have been studied in sixteen adults examined during the past year.

Straight Back Syndrome

“…This condition, should, therefore be considered in the differential diagnosis. However, physical examination and chest radiography both in posteroanterior and lateral positions are quite characteristic of the condition, and there is no difficulty in arriving at a diagnosis (Evans, 1946).…”

Long-term Cardiac Observation of Children

“…They have been classified and their characteristics described by Evans (1947). The majority are better heard in the reclining posture.…”

“…The distribution is shown in Table III. Evans (1946) has pointed out that with this deformity the heart may be flattened between the spine and the depressed sternum. This may give rise to a systolic murmur and also give an impression of cardiac enlargement by outward displacement of the apex beat.…”

Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification

“…During that era, several other hypotheses were postulated highlighting diseases such as syphilis, (fetal) rickets, poliomyelitis, mediastinitis, and upper airway obstructions as the underlying cause ( 20 - 24 ). Others advocated that the deformity is the result of long periods of mechanical stress on the sternum as seen in cobblers who use the anterior part of their chest as a working surface ( 25 , 26 ). They even considered the deformity a professional disease (i.e., cobblers’ chest).…”