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A pulse deficit between the PMI and periphery may occur in some arrhythmias, such as premature ventricular contraction or atrial fibrillation. Sustained apex beat, namely prolonged upward cardiac force during systole in a physical exam, can be seen in some chronic conditions such as hypertension and aortic stenosis, especially in elderly and ...
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.
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.
Apical pulse: located in the 5th left intercostal space, 1.25 cm lateral to the mid-clavicular line. In contrast with other pulse sites, the apical pulse site is unilateral, and measured not under an artery, but below the heart itself (more specifically, the apex of the heart). See also apex beat.
One can hear it at the left lower sternal border. One may also hear it at the right lower sternal border (when associated with a dilated aorta). Other possible exam findings are bounding carotid and peripheral pulses. These are also known as Corrigan's pulse or Watson's water hammer pulse. Another possible finding is a widened pulse pressure.
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 pulse may vary due to exercise, fitness level, disease, emotions, and medications. [11] The pulse also varies with age. A newborn can have a heart rate of 100–160 bpm, an infant (0–5 months old) a heart rate of 90–150 bpm, and a toddler (6–12 months old) a heart rate of 80–140 bpm. [ 12 ]
However, this rule can be misleading in situations where the stenosis is so severe that the flow becomes reduced, or during high-output situations such as pregnancy where a less severe stenosis may still produce a strong murmur. In mitral stenosis, tapping apical impulse is present. Mid-diastolic Tricuspid stenosis