The Apex Beat
March 4th, 2023
On this page:Displaced Apex BeatPressure-Loaded Apex BeatVolume-Loaded Apex BeatDouble Impulse Apex Beat
Overview
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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