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The intercostal space (ICS) is the anatomic space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it. Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.
The normal apex beat can be palpated in the precordium left 5th intercostal space, half-inch medial to the left midclavicular line and 3–4 inches left of left border of sternum. In children the apex beat occurs in the fourth rib interspace medial to the nipple.
An S3 heart sound is best heard with the bell-side of the stethoscope (used for lower frequency sounds). A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line.
[12] [13] The left nipple can be used as a reference for the level of the left 4th intercostal space. From here, the midaxillary 5th intercostal space is identified by moving inferiorly one intercostal space and laterally towards the midaxillary line.
Midaxillary line: A vertical line passing through the apex of the axilla. Posterior axillary line: A vertical line passing through the posterior axillary fold. Scapular line: A vertical line passing through the inferior angle of the scapula. Paravertebral line: A vertical line corresponding to the tips of the transverse processes of the vertebrae.
The midaxillary line is a coronal line on the torso between the anterior and posterior axillary lines. It is a landmark used in thoracentesis , [ 2 ] and the V6 electrode of the 10 electrode ECG. The posterior axillary line is a coronal line on the posterior torso marked by the posterior axillary fold .
The apex beat is found approximately in the fifth left intercostal space in the mid-clavicular line. It can be impalpable for a variety of reasons including obesity, emphysema, effusion and rarely dextrocardia. The apex beat is assessed for size, amplitude, location, impulse and duration.
In the fourth intercostal space (between ribs 4 and 5) just to the left of the sternum. V 3: Between leads V 2 and V 4. V 4: In the fifth intercostal space (between ribs 5 and 6) in the mid-clavicular line. V 5: Horizontally even with V 4, in the left anterior axillary line. V 6: Horizontally even with V 4 and V 5 in the mid-axillary line.