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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 ...
A forceful apex beat indicates left ventricular pressure overload, while a right ventricular heave suggests right ventricular pressure overload. Other signs provide evidence for specific causes of pressure overload. Hypertension is diagnosed by sphygmomanometry. A narrow pulse pressure is a sign of aortic stenosis.
A medical provider (e.g. doctor) may order tests for further evaluation of a heart murmur. The echocardiogram is a common test used. This is also known as an "echo" or ultrasound of the heart. [1] It shows the heart structures and blood flow through the heart. Further testing is usually done when symptoms that may be of concern are present.
Hyperdynamic apex Hyperdynamic precordium is a condition where the precordium (the area of the chest over the heart) moves too much (is hyper dynamic ) due to some pathology of the heart . That means a forceful and hyperdynamic impulse ( large amplitude that terminates quickly) can be palpated during physical examination. [ 1 ]
Pulse pressure is quantified using a blood pressure cuff and stethoscope (Korotkoff sounds), by measuring the variation of the systolic pressure during expiration and inspiration. [ 8 ] To measure the pulsus paradoxus, place a blood pressure cuff on the patient's arm and very slowly deflate the cuff while listening for brachial pulsations.
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Left ventricle is at right in image, serially sectioned from apex to near base. There are several sets of criteria used to diagnose LVH via electrocardiography. [10] None of them are perfect, though by using multiple criteria sets, the sensitivity and specificity are increased. The Sokolow-Lyon index: [11] [12]