A site for medical students - Practical,Theory,Osce Notes

Inspection of Apical impulse

Apical impulse is the outermost and the lowermost point over the precordium where a distinct impulse is seen or felt during each cardiac cycle. 
Apical impulse is formed due to the forward movement of the anatomical apex of leftventricle which produces an impulse on the precordium during each cardiac cycle. Normally apical impulse is visible in the 5th left intercostal space inside the mid clavicular line.
Causes of non visibility of apical impulse 
  • Thick chest wall
  • Apex beat behind the rib
  • Pericardial effusion
  • Left pleural effusion 
Displaced apex is observed in
Rightventricular enlargement displaces the apex horizontally and outwards,
Leftventricular  enlargement shifts the apex downward and outward.
Displaced heart-is due to pleuropulmonary disease and gross kyphoscoliosis.
Diffuse apex 
  • This is seen in ventricular aneurysm.