Inspection to the hand; increased pressure will

Inspection & Palpation of the Apical Impulse on Cardiac

Natalie Hoyte

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Setup: The clinician should stand on the patient’s right side;
the head of the bed may be elevated for patient comfort. Expose the patient’s
chest and if necessary, clinician or patient can move the left breast up and to
the left. Clinician will examine the apical impulse (AI) while patient is
supine, and again in the left lateral decubitus position (LLDP).


Inspection: The apical impulse is typically
visible at the left midclavicular line (MCL) in the 5th intercostal
space (ICS) for adults, (4th ICS for children), though the AI is easily
obscured by obesity, large breasts, or muscularity. You may shine tangential
light on this area to help visualize the pulsation of the AI. The point at which
the AI is most readily seen or felt should be described as the point of maximal impulse (PMI).


Palpation: Palpate apical area of precordium using
the proximal halves of the four fingers of the right hand. Touch lightly and
let cardiac movements rise to the hand; increased pressure will decrease the pulsatile
sensation. Then isolate AI/PMI using pads of 1 or 2 fingers and record location by ICS and distance from midsternal
line. Measure the diameter of the
impulse while patient is in LLDP (diameter typically


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