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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 ...
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.
[2] [3] The major way health care providers examine the heart on physical exam is heart auscultation; [3] another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. [4] A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the ...
The presence of a murmur at the apex can be misinterpreted as mitral regurgitation. However, the apical murmur of the Gallavardin phenomenon does not radiate to the left axilla and is accentuated by a slowing of the heart rate (such as a compensatory pause after a premature beat) whereas the mitral regurgitation murmur does not change. [2]
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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.