Left ventricular heave is caused by left ventricular hypertrophy. The hypertrophy can be physiological, such as in an athlete, or pathological, in heart failure commonly caused by ischaemia following a heart attack. The heave itself is basically the hypertrophied ventricle pushing the heel of an examiners hand of the chest wall when the heart pumps. Left ventricular heave is detectable when the hand is placed over the apex beat (normally 5th intercostal mid-clavicular line, although when hypertrophied it is more likely found near the anterior or mid axillary line)