Apex beat

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} The apex beat is the furthermost point outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be palpated. The cardiac impulse is the result of the heart rotating, moving forward and striking against the chest wall during systole.

The normal apex beat can be palpated in the precordium left 5th intercostal space, at the point of intersection with the left midclavicular line. The apex beat may also be found at abnormal locations; in many cases of dextrocardia, the apex beat may be felt on the right side

Lateral and/or inferior displacement of the apex beat usually indicates enlargement of the heart, also called cardiomegaly. The apex beat may also be displaced by other conditions:

Pleural or pulmonary diseases
Deformities of the chest wall or the thoracic vertebra

Sometimes, the apex beat may not be palpable, either due to a thick chest wall, or conditions where the stroke volume is reduced; such as during ventricular tachycardia or shock.

The character of the apex beat may provide vital diagnostic clues:

A forceful impulse indicates pressure overload in the heart(as might occur in hypertension)
An uncoordinated(dyskinetic) apex beat involving a larger area than normal indicates ventricular dysfunction; such as an aneurysm following myocardial infarction

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