{"id":1659,"date":"2010-12-07T14:12:37","date_gmt":"2010-12-07T14:12:37","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/apex-beat\/"},"modified":"2023-09-21T17:09:44","modified_gmt":"2023-09-21T16:09:44","slug":"cve-apex-beat","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-cardiovascular-examination\/palpation-the-cardiovascular-examination\/cve-apex-beat\/","title":{"rendered":"Apex Beat"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>left ventricle<\/strong><\/span> has a point that <span style=\"text-decoration: underline;\">beats<\/span> against the chest. This phenomenon is termed the <span style=\"color: #33cccc;\"><strong>apex beat<\/strong><\/span>. Due to the heart apex lying close to the <span style=\"color: #33cccc;\"><strong>thoracic wall<\/strong><\/span> in the <span style=\"text-decoration: underline;\">left semi-prone position<\/span>, the apex beat is more clearly <span style=\"text-decoration: underline;\">palpable<\/span> in this position. Therefore, the <span style=\"text-decoration: underline;\">position<\/span> of the apex beat should be determined in the supine position. The <em>other characteristics<\/em> of the apex beat should be determined in the left semi-prone position. <\/span><\/p>\n<p><span style=\"color: #003366;\">In a significant number of adults, the apex beat <span style=\"text-decoration: underline;\">cannot<\/span> be palpated in the supine position. Thus, it will be impossible to determine the <span style=\"text-decoration: underline;\">location<\/span> of the apex beat. In such cases, the location of the apex beat and its characteristics can sometimes be assessed in the <span style=\"color: #33cccc;\"><strong>semi-prone position<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Locating The Apex Beat<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">The patient is initially examined in the <span style=\"color: #33cccc;\"><strong>supine position<\/strong><span style=\"color: #003366;\">. <\/span><\/span><\/span><span style=\"color: #003366;\">Normally, the apex beat is located in the <span style=\"color: #33cccc;\"><strong>4th or 5th intercostal space<\/strong><\/span> on\/within the <span style=\"color: #33cccc;\"><strong>midclavicular<\/strong><\/span> line. If the apex beat is located <span style=\"text-decoration: underline;\">more to the left<\/span>, then the heart is <span style=\"color: #33cccc;\"><strong>enlarged<\/strong><\/span> (<em>cardiomegaly<\/em>) or <strong><span style=\"color: #33cccc;\">displaced<\/span><\/strong>.<\/span><br \/>\n<span style=\"color: #003366;\">Place a hand on the <span style=\"text-decoration: underline;\">left half of the thorax<\/span> with the fingers <em>parallel<\/em> to the <span style=\"text-decoration: underline;\">intercostal spaces<\/span>. The breasts should be <em>carefully<\/em> pushed upwards when examining <span style=\"color: #33cccc;\"><strong>female patients<\/strong><\/span>. Use the <span style=\"text-decoration: underline;\">flat of the hand<\/span> to gain a general impression of the overall location of the apex beat. Use 2 or 3 fingertips to determine the position of the apex beat more <em>accurately<\/em>.\u00a0<em><strong>[Figures 5, 6]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1656\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-5.jpg\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-5.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-5-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 5: Locating The Apex Beat (1)<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1657\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-6.jpg\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-6.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-6-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 6: Locating The Apex Beat (2)<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Duration Of The Apex Beat<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Upon determining the location of the apex beat, examine the <span style=\"text-decoration: underline;\">other characteristics<\/span> in the <span style=\"color: #33cccc;\"><strong>left semi-prone position<\/strong><\/span>.<em><strong>\u00a0[Figure 7]<\/strong><\/em>. <\/span><span style=\"color: #003366;\">The impulse of the apex beat should not last any longer than <span style=\"color: #33cccc;\"><strong>one-third of systole<\/strong><\/span>. If the impulse persists for longer, it is referred to as <span style=\"color: #33cccc;\"><strong>sustained<\/strong><\/span>. This is indicative of <span style=\"color: #33cccc;\"><strong>left ventricular pressure overload<\/strong><\/span> (<em>concentric left ventricular hypertrophy<\/em>). <\/span><span style=\"color: #003366;\">Palpate using the flat of the hand and then the fingertips. The duration of the apex beat compared to the duration of systole is estimated by <span style=\"text-decoration: underline;\">simultaneously<\/span> <span style=\"color: #33cccc;\"><strong>palpating<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>auscultating<\/strong><\/span> (<em>systole is located between the 1st and 2nd tone<\/em>).<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1658\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Cardiovascular_cv-fig-7.jpg\" width=\"400\" height=\"294\" \/><strong><span style=\"width: 400px; display: block;\">Figure 7: Assessing The Characteristics Of The Apex Beat<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Area Of The Apex Beat<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Assess the <span style=\"color: #33cccc;\"><strong>size<\/strong><\/span> of the apex beat in the <span style=\"text-decoration: underline;\">left semi-prone position<\/span> using the flat of the hand and follow with fingertips. <\/span><span style=\"color: #003366;\">Normally, the <span style=\"text-decoration: underline;\">diameter<\/span> of the apex beat area lies within just <span style=\"color: #33cccc;\"><strong>one intercostal space<\/strong><\/span>. If the apex beat can be palpated over <span style=\"text-decoration: underline;\">more than one<\/span> intercostal space, it is known as a <span style=\"color: #33cccc;\"><strong>displaced apex beat<\/strong><\/span>. <\/span><span style=\"color: #003366;\">A displaced apex beat is indicative of <span style=\"color: #33cccc;\"><strong>ventricular dilatation<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>cardiac aneurysm formation<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Amplitude Of The Apex Beat<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">In the <span style=\"text-decoration: underline;\">left semi-prone position<\/span>, use the <span style=\"text-decoration: underline;\">fingertips<\/span> to estimate the <span style=\"color: #33cccc;\"><strong>intensity<\/strong><\/span> of the apex beat as <em>normal<\/em>, <em>strong<\/em> or <em>weak<\/em>.\u00a0 <\/span><span style=\"color: #003366;\">A <span style=\"text-decoration: underline;\">strong<\/span> apex beat can be associated with <span style=\"color: #33cccc;\"><strong>pressure overload<\/strong><\/span> (<em>aortic stenosis<\/em>), <span style=\"color: #33cccc;\"><strong>volume overload<\/strong><\/span> (<em>mitral insufficiency<\/em>) or <span style=\"color: #33cccc;\"><strong>hyperdynamic circulation<\/strong><\/span> (<em>anaemia<\/em>). <\/span><span style=\"color: #003366;\">A <span style=\"text-decoration: underline;\">weak<\/span> apex beat can be found in the event of <span style=\"color: #33cccc;\"><strong>hypovolaemia<\/strong><\/span> (<em>shock as a consequence of underfilling of the vascular system<\/em>), <span style=\"color: #33cccc;\"><strong>pericardial effusion<\/strong><\/span> (<em>fluid in the heart sac<\/em>) or <span style=\"color: #33cccc;\"><strong>constrictive pericarditis<\/strong><\/span> (<em>inflammation of the heart sac as a result of which cardiac contraction and expansion is impaired<\/em>).<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Composition Of The Apex Beat<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Repeat palpation using the fingertips, with the patient in the <span style=\"text-decoration: underline;\">left semi-prone position<\/span>. Assess whether the apex beat consists of a <span style=\"color: #33cccc;\"><strong>single impulse<\/strong><\/span> or whether there is an <span style=\"color: #33cccc;\"><strong>extra impulse<\/strong><\/span> before the strong impulse. The latter is referred to as a <span style=\"color: #33cccc;\"><strong>double<\/strong><\/span> (<em>bifid<\/em>) apex beat and is always <span style=\"text-decoration: underline;\">pathological<\/span>. It is caused by <span style=\"text-decoration: underline;\">increased atrial emptying<\/span>, which cannot normally be felt, but in this case, can be palpated. This occurs with left atrial volume or pressure overload (<em>mitral insufficiency or left ventricular hypertrophy<\/em>).<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The left ventricle has a point that beats against the chest. This phenomenon is termed the apex beat. Due to the heart apex lying close to the thoracic wall in the left semi-prone position, the apex beat is more clearly palpable in this position. Therefore, the position of the apex beat should be determined in [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[117],"tags":[120],"class_list":["post-1659","post","type-post","status-publish","format-standard","hentry","category-palpation-the-cardiovascular-examination","tag-the-cardiovascular-examination"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Apex Beat - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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