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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 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).
Signs of infants associated with serious cases of PDA are poor feeding, failure to thrive and respiratory distress. Other examination findings may include widened pulse pressures and bounding pulses. A machinery murmur is also known as a Gibson murmur. [20] Systolic murmur loudest below the left scapula Classic for a coarctation of the aorta.
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.
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]
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.