I. Mechanism

  1. Heart apex rotates forward with systole

II. Normal impulse location

  1. Fifth intercostal space
  2. Left of mid-Sternum by 7 to 9 cm
  3. Medial to left midclavicular line by 1-2 cm

III. Accentuated Impulse

  1. Findings suggestive of Left Ventricular Hypertrophy
    1. Impulse > 3 cm diameter (stethoscope diaphragm size)
      1. Patient in Left Lateral Decubitus
      2. Palpation of apex
    2. Accuracy (Compared with Echocardiogram)
      1. Sensitivity: 92%
      2. Specificity: 91%
    3. Reference
      1. Eileen (1983) Ann Intern Med 99(5):628-30 [PubMed] (or open in [QxMD Read])
  2. Causes
    1. Left Ventricular Hypertrophy
    2. Increased myocardial tone
      1. Exertion
      2. Emotion
      3. Thyrotoxicosis
      4. Digoxin Toxicity

IV. Shifted Position of PMI

  1. PMI shifted left
    1. Cardiac dilatation suggestive of CHF
      1. Test Sensitivity: 66%
      2. Test Specificity: 95%
    2. Other causes
      1. Right Pneumothorax
      2. Left pleural adhesions
  2. PMI shifted right
    1. Left Pneumothorax
    2. Right pleural adhesions

V. References

  1. Degowin (1987) Bedside Diagnostics, Macmillan, p. 344

Images: Related links to external sites (from Google)

Ontology: Apex beat (C0277909)

Concepts Biologic Function (T038)
SnomedCT 68031002
English Apex beat present, Apex beat, function, Cardiac impulse, apex beat, cardiac impulses, apical impulse, cardiac impulse, apex beats, Apical impulse, Apical thrust, Apex beat, function (observable entity), Apex beat, Apex beat (function)
Spanish choque de la punta (entidad observable), choque de la punta, choque de punta (función), latido apical

Ontology: Apex beat displaced (C0425602)

Concepts Finding (T033)
SnomedCT 248661003
English Apex beat displaced, Apex beat displaced (finding)
Spanish latido del vértice desplazado (hallazgo), latido del vértice desplazado, latido del ápex desplazado

Ontology: Finding of apex beat (C0578482)

Concepts Finding (T033)
SnomedCT 301803006
Spanish latido del vértice - hallazgo, choque de la punta - hallazgo, latido del vértice - hallazgo (hallazgo), latido de la punta - hallazgo, hallazgo relacionado con el latido de la punta (hallazgo), hallazgo relacionado con el choque de la punta, hallazgo relacionado con el latido de la punta, latido del ápex - hallazgo
English Observation of apex beat, Finding of apex beat (finding), Finding of apex beat