apex beat

The apex beat may also be displaced by other conditions:

An algorithm for the classification of some common apex beat characters is shown in the image.

The character of the apex beat may provide vital diagnostic clues:

The apex beat is assessed for size, amplitude, location, impulse and duration.

The apex beat is found approximately in the 5th intercostal space in the mid-clavicular line.

In children the apex beat occurs in the fourth rib interspace medial to the nipple.

The mitral component of the first heart sound is usually soft and with a laterally displaced apex beat, often with heave.

The normal apex beat can be palpated in the precordium left 5th intercostal space, at the point of intersection with the left midclavicular line.

Larger VSDs may cause a parasternal heave, a displaced apex beat (the palpable heartbeat moves laterally over time, as the heart enlarges).

The apex beat may also be found at abnormal locations; in many cases of dextrocardia, the apex beat may be felt on the right side.

Sometimes, the apex beat may not be palpable, either due to a thick chest wall, or conditions where the stroke volume is reduced; such as during ventricular tachycardia or shock.

Upon auscultation of an individual with mitral stenosis, the first heart sound is unusually loud and may be palpable (tapping apex beat) because of increased force in closing the mitral valve.

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 the largest amplitude.

Additional signs indicating left ventricular failure include a laterally displaced apex beat (which occurs if the heart is enlarged) and a gallop rhythm (additional heart sounds) may be heard as a marker of increased blood flow, or increased intra-cardiac pressure.