Apex beat may not be palpable due to following reasons.
1.Postural change.
- Apex beat lying behind the rib
- Obesity or thick chest wall
- Emphysema
- Pleural effusion
- Pericardial effusion
- Constructive pericarditis
- Pneumothroax
- Deformity of chest wall – kyphoscoliosis
- Pendular breast in females
- Acute myocardial infarction
- Heart failure
- Dextro cardia
1.Postural change.
First patient is put in the supine position and palpate for the apex.
If still not felt patient is put in the sitting and stooping forwards position.
In both these situations the term apical impulse is used instead of apex beat because the true position of apex beat is altered.
If still not felt patient is put in the sitting and stooping forwards position.
In both these situations the term apical impulse is used instead of apex beat because the true position of apex beat is altered.
2.Percussion
