II. Mechanism
- Heart apex rotates forward with systole
III. Normal impulse location
- Fifth intercostal space
- Left of mid-Sternum by 7 to 9 cm
- Medial to left midclavicular line by 1-2 cm
IV. Accentuated Impulse
- Findings suggestive of Left Ventricular Hypertrophy
- Impulse > 3 cm diameter (stethoscope diaphragm size)
- Patient in Left Lateral Decubitus
- Palpation of apex
- Accuracy (Compared with Echocardiogram)
- Sensitivity: 92%
- Specificity: 91%
- Reference
- Impulse > 3 cm diameter (stethoscope diaphragm size)
- Causes
- Left Ventricular Hypertrophy
- Increased myocardial tone
- Exertion
- Emotion
- Thyrotoxicosis
- Digoxin Toxicity
V. Shifted Position of PMI
- PMI shifted left
- Cardiac dilatation suggestive of CHF
- Test Sensitivity: 66%
- Test Specificity: 95%
- Other causes
- Right Pneumothorax
- Left pleural adhesions
- Cardiac dilatation suggestive of CHF
- PMI shifted right
- Left Pneumothorax
- Right pleural adhesions
VI. References
- Degowin (1987) Bedside Diagnostics, Macmillan, p. 344
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Related Studies
| 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 | Cardiac apical thrust displaced, 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 |
