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What is the significance of apex beat

Apex beat will give idea about enlargement of cardiac chambers and activity of myocardium.
How to localise the apex beat
1.  Ask the patient to lie flat
2.  Stand on the right side of patient
3.  Place your right palm over the pericardium
4.  With the pulp of the finger localise he definite impulse
5.  Locate the thrust by counting the ribs and measure how far it is from midclavicular line.
6.  If the apex beat is not palpated in dorsal decubitus posture. Make the patient sit and lean forward and try.
7.  If not palpated in sitting also look for apical thrust on right side of chest – to rule out dextrocardia.
8.  If then not palpable comment as could not be localised properly.
You should not localise the apex beat in the left lateral position because there is shift of apex beat to the left side for about 1-2cm in the left lateral position.
Where is the position of normal apex beat
    Normal apex beat is in the left 5th intercostal space half inch medial to midclavicular line.
What are the causes of nonpalpable apex beat
Apex beat may not be palpable due to following reasons.
1.  Apex beat lying behind the rib
2.  Obesity or thick chest wall
3.  Emphysema
4.  Pleural effusion
5.  Pericardial effusion
6.  Constrictive pericarditis
7.  Pneumothroax
8.  Deformity of chest wall – kyphoscoliosis
9.  Pendular breast in females
10. Acute myocardial infarction
11. Heart failure
12. Dextrocardia
What are the different characters of apex beat
1.  Normal apex beat :It is in the left 5th intercostal  ½ inch medial to left midclavicular line, a brief tap confined to an area of 2- 3 cm diameter. Not much forceful.
2.  Hyperdynamic : Apex beat means forceful and ill sustained impulse occur due to diastolic overload of left ventricle, occur in mitral regurgitation, aortic regurgitation, ventricular septal defect and patent ductus arteriosus. There is no obstruction of blood flow from let ventricle.
3.  Heaving apex beatHere it is forceful and well sustained occur due to systolic overload of ventricle. Apex beat is well sustained due to obstruction of left ventricular outflow. Examples are aortic stenosis, systemic hypertension, coarctation of aorta, obstructive cardiomyopathy.
4.  Tapping apexApex beat is of low amplitude and it is ill sustained occur in mitral stenosis and tachycardia.
5.  Hypokinetic apex beat Thrust of apex beat is minimal. Occur in myocardial infarction, pericardial effusion, constrictive pericarditis, myxoedema shock.