The pathophysiology depends on the specific cause of<unk> . Most causes can be attributed to one of four main mechanisms. These include<unk>  ventricular hypertrophy, reduced muscle mass of left ventricle, altered conduction pathways and change in the position of the heart in the chest.<unk>  ventricular hypertrophy Enlargement of<unk>  ventricular myocardial mass can result in<unk> . There are 2 main reasons for this mechanism. Firstly, more muscle mass will result in greater amplitude of depolarisation of that side of the heart. Secondly, depolarisation of the heart will be slower through the<unk>  ventricle relative to the left, and therefore the effects of the<unk>  ventricle on the<unk>  of the heart will be dominant. Left ventricular atrophy Decrease in myocardial mass of the left ventricle will shift the balance of depolarisation towards the<unk> . For example, scarring and atrophy caused by ischaemia of the left ventricle will cause depolarisation of the left side of the heart to be less forceful. Hence, depolarisation of the<unk>  ventricle will be greater in amplitude than left, shifting the<unk>  to the<unk> . Conduction abnormalities Changes in the conduction pathways of the heart can result in<unk> . For example, an accessory pathway from the left atrium to the left ventricle, as in Wolff-Parkinson-White Syndrome, will result in the left ventricle finishing depolarisation earlier than the<unk> . Hence, the<unk>  ventricle will have more of an effect on the<unk>  of the heart. Position of heart in the chest The apex of the heart is normally orientated towards the left. A more vertical orientation of the heart, shifts the<unk>  to the<unk> . Physiologically, this can occur in tall and thin individuals. Pathologically, conditions such as a left-sided pneumothorax and lung hyperinflation (e.g. COPD) can cause<unk> wards displacement of the heart. The congenital condition of dextrocardia results in<unk> .
Right axis deviation
Pulsus alternans
Dichotic pitch
Heart click
Shifting dullness
Apex beat
Precordial thump
Third heart sound