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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.
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.
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.
Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. [1] This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. [2] The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing.
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The murmur is low intensity, high-pitched, best heard over the left sternal border or over the right second intercostal space, especially if the patient leans forward and holds breath in full expiration. The radiation is typically toward the apex. The configuration is usually decrescendo and has a blowing character.