Apex beat
The apex beat (lat. ictus cordis), also called the apical impulse,[1] is the pulse felt at the point of maximum impulse (PMI), which is the point on the precordium farthest outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt. The cardiac impulse is the vibration resulting from the heart rotating, moving forward and striking against the chest wall during systole. The PMI is not the apex of the heart but is on the precordium not far from it.
Identification
The normal apex beat can be palpated in the precordium left 5th intercostal space, half inch medial to the left midclavicular line and 3-4 inches left of left border of sternum. In children the apex beat occurs in the fourth rib interspace medial to the nipple. The apex beat may also be found at abnormal locations; in many cases of dextrocardia, the apex beat may be felt on the right side.
Interpretation
Algorithm for classification of the apex beat characters
Lateral and/or inferior displacement of the apex beat usually indicates enlargement of the heart, called cardiomegaly. The apex beat may also be displaced by other conditions:
- Pleural or pulmonary diseases
- Deformities of the chest wall or the thoracic vertebrae
Sometimes, the apex beat may not be palpable, either due to a thick chest wall, or conditions where the stroke volume is reduced; such as during ventricular tachycardia or shock.
The character of the apex beat may provide vital diagnostic clues:
- A forceful impulse indicates volume overload in the heart (as might occur in aortic regurgitation)
- An uncoordinated (dyskinetic) apex beat involving a larger area than normal indicates ventricular dysfunction; such as an aneurysm following myocardial infarction
- A pulse deficit between the PMI and periphery may occur in some arrhythmias, such as premature ventricular contraction or atrial fibrillation.
Sustained Apex Beat, namely prolonged upward cardiac force during systole in a physical exam, can be seen in some chronic conditions such as hypertension and aortic stenosis, especially in elderly and female gender.[2]
An algorithm for the classification of some common apex beat characteristics is shown in the image
References
- Lynn S. Bickley; Peter G. Szilagyi (1 December 2008). Bates' guide to physical examination and history taking. Lippincott Williams & Wilkins. pp. 357–. ISBN 978-0-7817-8058-2.
- https://webcampus.drexelmed.edu/Skills/assessments/cardiac/cardiacanswer.htm