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The apex beat (lat. ictus cordis), also called the apical impulse, [1] is the pulse felt at the point of maximum impulse (PMI), which is the point on the precordium farthest outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt.
The apex beat is assessed for size, amplitude, location, impulse and duration. There are specific terms to describe the sensation such as tapping, heaving and thrusting. Often the apex beat is felt diffusely over a large area, in this case the most inferior and lateral position it can be felt in should be described as well as the location of ...
A parasternal heave, lift, [1] or thrust [2] is a precordial impulse that may be felt (palpated) in patients with cardiac or respiratory disease. Precordial impulses are visible or palpable pulsations of the chest wall, which originate on the heart or the great vessels .
Hyperdynamic apex Hyperdynamic precordium is a condition where the precordium (the area of the chest over the heart) moves too much (is hyper dynamic ) due to some pathology of the heart . That means a forceful and hyperdynamic impulse ( large amplitude that terminates quickly) can be palpated during physical examination. [ 1 ]
Findings on clinical examination depend on the severity and duration of MR. The mitral component of the first heart sound is usually soft and with a laterally displaced apex beat, [6] often with heave. [7] The first heart sound is followed by a high-pitched holosystolic murmur at the apex, radiating to the back or clavicular area. [6]
Upon auscultation of an individual with mitral stenosis, the first heart sound is usually loud and may be palpable (tapping apex beat) because of increased force in closing the mitral valve. The first heart sound is made by the mitral and tricuspid heart valves closing.
A forceful apex beat indicates left ventricular pressure overload, while a right ventricular heave suggests right ventricular pressure overload. Other signs provide evidence for specific causes of pressure overload. Hypertension is diagnosed by sphygmomanometry.
Rarely, there may be cyanosis, altered level of consciousness, a hyperresonant percussion note on examination of the affected side with reduced expansion and decreased movement, pain in the epigastrium (upper abdomen), displacement of the apex beat (heart impulse), and resonant sound when tapping the sternum. [16]