Palpability of the Apex Beat

1. About how often can you expect to feel an apex beat in normal subjects over age 40?

ANS: Only in about one out of five [1]. However, in about 90% of children and teenagers, an apex beat is palpable in the sitting position. An apex beat is much more likely to be palpable in the sitting than in the supine position because in the latter, the heart falls away from the anterior chest wall. In the left lateral decubitus position, however, the apex beat may be palpable in about four out of five older adults, and in most children and young adults. It may require elevation of the chest to about 30° and various degrees of left lateral rotation in order to palpate a subtle apex beat.

2. How does obesity or a thick chest affect palpability of an apex beat? Their significance?

ANS: A thick chest in an obese young person does not necessarily make the normal LV impulse impalpable, probably because the heart is physiologically enlarged in obesity. However, if the chest wall is thick and the pos-teroanterior diameter is increased in a patient over age 50, the mere palpability of an apex impulse may be used as a sign of cardiomegaly.

3. What unusual approach may sometimes help you to feel a subtle apex beat or an unexpectedly posterior axillary line apex beat?

ANS: You should establish a routine of palpation from behind as well as from the front. A subtle apex beat may only be perceived when the hand palpates from a quiet immobile area like the back. The anterior chest is often disturbed by left parasternal movements and heart sound vibrations. Also, a frontal approach alone might mislead you into thinking that the movement you palpate on the anterior chest wall is the most lateral impulse when, in fact, it may be only an RV movement or an aneurysm, and the true LV apex beat may be missed because it may be near the posterior axillary line.

Note: When examining for an apex beat on a new patient, also palpate the right anterior chest (in the sitting position) so as not to miss a diagnosis of dextrocardia.

4. During what phase of respiration is the apex beat most palpable?

ANS: The apex beat may come out between the ribs during any phase of respiration.

5. Which part of the hand is best for feeling the faint localized movement of a subtle apex beat? The right hand or the left hand?

ANS: The fingertips or the area just proximal to them seems best for feeling a faint localized movement. Try each hand separately. Some examiners find that the fingers of one hand, usually the left in right-handed physicians, are more sensitive than the fingers of the other hand.

Note: It is easy to mistake the vibrations of the first sound for a slight impulse, especially if it is not appreciated that heart sounds may be palpable.

A posterior in addition to an anterior approach may allow you to feel more subtle movements, especially if your left hand is more sensitive than your right.

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Responses

  • Max
    Is palpation of the apex beat used?
    8 months ago
  • fiori
    What is apex beat palpable?
    6 months ago

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