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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.
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)
The latter can be seen in cases with left ventricle hypertrophy or outflow obstruction. Another possible cause of sustained impulse is heart failure with reduced ejection fraction. [1] Hyperdynamic precordium can also be due to hyperthyroidism, and thus indicates an increased cardiac contractility, with systolic hypertension.
During development, the majority of the heart muscle is a sponge-like meshwork of interwoven myocardial fibers. As normal development progresses, these trabeculated structures undergo significant compaction that transforms them from spongy to solid. This process is particularly apparent in the ventricles, and particularly so in the left ...
This impulse may also be felt in dilated right ventricular myopathy. The palpation of dilated myopathy differs in that the impulse tends to be vigorous and brief. This is in contrast with the sustained impulse of the hypertrophied right ventricle. [5] A parasternal heave may also be felt in mitral stenosis. [6]
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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 ...
Hypertrophic cardiomyopathy (HCM, or HOCM when obstructive) is a condition in which muscle tissues of the heart become thickened without an obvious cause. [8] The parts of the heart most commonly affected are the interventricular septum and the ventricles. [10]