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Golden Rules for examination of apex beat

Before commenting on the position and character of apical impulse,you should search for the presence of chest wall or spinal deformities, and the tracheal position.
When the apical impulse is not localisable on the left side, palpate the right hemithorax for its presence dextrocardia or pseudo-dextrocardia

How to localise the apex beat?
  • Ask the patient to be in supine position
  • Stand on the right side of patient
  • Place your right palm over the pericardium. First, you should palpate the apex with the palm, then digital localization is done with the finger tip
  • With the pulp of the finger localise the definite impulse
  • Locate the thrust by counting the ribs and measure how far it is from midclavicular line.
  • Watch the amplitude and duration of the lift of the palpating finger.
  • If the apex beat is not palpated in dorsal deculbitus posture,make the patient sit and lean forward and try.
  • If not palpated in sitting also look for apical thrust on right side of the chest this is to rule out dextrocardia.
  • If then not palpable comment as could not be localised properly.
  • You should not localise the apex beat in the left lateral position because there is shift of apex beat to the left side for about 1-2cm in the left lateral position