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Point of Maximum Impulse

Aka: Point of Maximum Impulse, Apical Thrust, Displaced Cardiac Apex, PMI

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

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
Sources	Derived from the NIH UMLS (Unified Medical Language System)

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
Sources	Derived from the NIH UMLS (Unified Medical Language System)

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
Sources	Derived from the NIH UMLS (Unified Medical Language System)

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 5/17/2008 and last published on 5/14/2013.

This is one of 5887 pages in the Family Practice Notebook