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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 ...
Left ventricular function can be assessed by determining the apical impulse. A normal or hyperdynamic apical impulse suggests good ejection fraction and primary MR. A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe MR. This type of murmur is known as the Castex Murmur. Holosystolic (pansystolic)
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 ]
Parasternal heave occurs during right ventricular hypertrophy (i.e. enlargement) or very rarely severe left atrial enlargement. [4] This is due to the position of the heart within the chest: the right ventricle is most anterior (closest to the chest wall).
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Impulse Tracker is a multi-track music tracker (music sequencer). Originally released in 1995 by Jeffrey Lim as freeware with commercial extensions, it was one of the last tracker programs for the DOS platform. [1] In 2014, on its 20th anniversary, Impulse Tracker became open-source software and the source code was released.