Apex beat - wikipedia Apex beat This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. ( December 2009 ) The apex beat ( lat. ictus cordis ), also called the apical impulse, 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. Contents 1 Identification 2 Interpretation 3 References 4 External links Identification The normal apex beat can be palpated in the precordium left 5th intercostal space, half inch medial to the left midclavicular line. 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. An algorithm for the classification of some common apex beat characteristics is shown in the image. References Jump up ^ 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. Retrieved 1 May 2013. External links Examination of Cardiac Apex Beat Medical examination and history taking Medical history Chief complaint History of the present illness Systems review Nursing assessment Allergies Medications Past medical history Surgical history Family history Social history Psychiatric history Progress notes Mnemonics SAMPLE OPQRST SOAP COASTMAP Physical examination General / IPPA Inspection Auscultation Palpation Percussion Vital signs Temperature Heart rate Blood pressure Respiratory rate HEENT Oral mucosa TM Eyes ( Ophthalmoscopy, Swinging - flashlight test ) Hearing ( Weber, Rinne ) Respiratory Respiratory sounds Cyanosis Clubbing Cardiovascular Precordial examination Peripheral vascular examination Heart sounds Other Jugular venous pressure Abdominojugular test Carotid bruit Ankle - brachial pressure index Abdominal Digestive Liver span Rectal Murphy 's sign Bowel sounds Urinary Murphy 's punch sign Extremities / Joint Back ( Straight leg raise ) Knee ( McMurray test ) Hip Wrist ( Tinel sign, Phalen maneuver ) Shoulder ( Adson 's sign ) GALS screen Neurological Mental state Mini -- mental state examination Cranial nerve examination Upper limb neurological examination Neonatal Apgar score Ballard Maturational Assessment Gynecological Well - woman examination Vaginal examination Breast examination Cervical motion tenderness Assessment and plan Medical diagnosis Differential diagnosis Symptoms and signs relating to the cardiovascular system ( R00 -- R03, 785 ) Chest pain Referred pain Angina Aerophagia Auscultation Heart sounds Split S2 S3 S4 Gallop rhythm Heart murmur Systolic Diastolic Continuous Pericardial friction rub Heart click Bruit carotid Pulse Tachycardia Bradycardia Pulsus tardus et parvus Pulsus paradoxus doubled Pulsus bisferiens Dicrotic pulse Pulsus bigeminus Pulsus alternans Pulse deficit Vascular disease Gangrene Other Palpitations Apex beat Cœur en sabot Jugular venous pressure Cannon A waves Hyperaemia Shock Cardiogenic Hypovolemic Distributive Septic Neurogenic Retrieved from `` https://en.wikipedia.org/w/index.php?title=Apex_beat&oldid=789534988 '' Categories : Cardiology Hidden categories : Articles needing additional references from December 2009 All articles needing additional references Use dmy dates from May 2011 Talk Contents About Wikipedia Euskara Français Polski Português Edit links This page was last edited on 7 July 2017, at 23 : 10. 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Question: where is the point of maximal impulse (pmi) normally located
Answer: the point on the precordium farthest outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt