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Impalpable apex beat

Apex beat may not be palpable due to following reasons.
  • Apex beat lying behind the rib
  • Obesity or thick chest wall
  • Emphysema
  • Pleural effusion
  • Pericardial effusion
  • Constructive pericarditis
  • Pneumothroax
  • Deformity of chest wall – kyphoscoliosis
  • Pendular breast in females
  • Acute myocardial infarction
  • Heart failure
  • Dextro cardia
Procedures to be followed if apex beat is not palpable.
1.Postural change.
First patient is put in the supine position and palpate for the apex.
If still not felt patient is put in the sitting and stooping forwards position.
In both  these situations the term apical impulse is  used instead of apex beat because the true position of apex beat is altered.