How will you differentiate between left ventricular and right ventricular apex

Left ventricular type of apex

• Here the apex beat goes downward and outward.
• Impulse is felt in large area
• Impulse maximum felt at apex
• If there is left parasternal heave it is asynchronous with apex beat

Right ventricular type of apex

• Apex goes outwards
• Impulse is maximum over the lower left sternal border
• Left parasternal heave is consistent with the apex beat.