Cardiovascular Medicine Book

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Point of Maximum ImpulseAka: Apical Thrust, Displaced Cardiac Apex, PMI

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  1. Mechanism
    1. Heart apex rotates forward with systole
  2. 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
  3. 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
    2. Causes
      1. Left Ventricular Hypertrophy
      2. Increased myocardial tone
        1. Exertion
        2. Emotion
        3. Thyrotoxicosis
        4. Digoxin Toxicity
  4. 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
  5. References
    1. Degowin (1987) Bedside Diagnostics, Macmillan, p. 344

Apex beat (C0277909)

ConceptsBiologic Function (T038)
EnglishApex beat, Apical impulse, Apical thrust, Cardiac impulse
Spanishchoque de la punta, latido apical
Parent ConceptsCardiac function (C0232164), Anatomical point (C0504079)
SourcesMTH, SCTSPA, SNOMEDCT, UWDA
Derived from the NIH UMLS (Unified Medical Language System)


Apex beat displaced (C0425602)

ConceptsFinding (T033)
EnglishApex beat displaced
Spanishlatido del apex desplazado, latido del vertice desplazado
Parent ConceptsPosition of apex beat - finding (C1287711)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Finding of apex beat (C0578482)

ConceptsFinding (T033)
EnglishFinding of apex beat, Observation of apex beat
Spanishlatido del apex - hallazgo, latido del vertice - hallazgo
Parent ConceptsCardiac finding (C0577785)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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