Apical rocking

Last revised by Dr Joachim Feger on 24 Sep 2021

Apical rocking is a radiographic sign that might be seen either on echocardiography or cine imaging on cardiac MRI in the four-chamber view and refers to a movement of the cardiac apex in cardiac dyssynchrony. It is characterized by the following 1-3:

  • short-timed movement of the apex towards the interventricular septum during early systole
  • longer movement of the apex towards the lateral free wall during the ejection phase

Related pathology

The short septal movement of the cardiac apex is caused by an early contraction of the septum, the following slower lateral apical movement occurs due to the dyssynchronous contraction of the lateral wall that occurs later 1-3. The extent of the movement is considered proportional to the end-diastolic volume and not related to the duration of the QRS complex 1.

The sign is interrelated with septal flash both indicating ventricular dyssynchrony that can be associated with the following clinical conditions 1,2:

See also

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