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Cardio Exam

The Apex Beat

March 4th, 2023


  • How to Assess

  • With the tips of the fingers, palpate for the most inferior and lateral point at which the cardiac impulse is clearly palpable.
  • Normal Position

  • The fifth intercostal space in the midclavicular line.
  • Interpretation

  • Displaced apex beat - palpable in the axillaCardiomegaly, right tension pneumothorax
  • Forceful and sustained impulse (pressure loaded)Left ventricular hypertrophy
  • Forceful and non-sustained impulse (volume loaded)Hypermetabolic states, aortic / mitral regurgitation, ventricular septal defect
  • Double impulseHypertrophic cardiomyopathy

Displaced Apex Beat

  • Feel For

  • The apex beat palpable in the axilla.
  • Causes of Displaced Apex Beat

  • Cardiomegaly - idiopathic, cardiomyopathy, congestive cardiac failure, aortic regurgitation, mitral regurgitation, ventricular septal defect
  • Right-sided tension pneumothorax

Pressure-Loaded Apex Beat

  • Feel For

  • A forceful and sustained apical impulse.
  • Significance

  • A sign of left ventricular hypertrophy.

Volume-Loaded Apex Beat

  • Feel For

  • A forceful and non-sustained impulse with displacement of the apex.
  • Causes of Volume Loaded Apex

  • Hypermetabolic states
  • Aortic regurgitation
  • Mitral Regurgitation
  • Ventricular Septal Defect

Double Impulse Apex Beat

  • Feel For

  • A twice-beating apex.
  • Significance

  • A sign of hypertrophic cardiomyopathy.
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