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How will you differentiate between left ventricular and right ventricular apex

Left ventricular type of apex
  • Here the apex beat goes downward and outward.
  • Impulse is felt in large area
  • Impulse maximum felt at apex
  • If there is left parasternal heave it is asynchronous with apex beat
Right ventricular type of apex
  • Apex goes outwards
  • Impulse is maximum over the lower left sternal border
  • Left parasternal heave is consistent with the apex beat.