Apex Beat: A quick review

 

Cardiac Apex Beat

 

Definition

It is the lowermost and outermost, definitely palpable cardiac impulse

When you find a paplpable apex beat then ensure

  1.Site (localize in which intercostal space. Do not forget dextrocardia, where it is on the right

side). Its normal position is in the fifth left intercostal space, 1 centimetre medial to the midclavicular line

 2.Distance from midline (measure with tape) normally 9 cm from midline

 3.Nature/Character (normal, tapping, heaving, thrusting and diffuse)

 

Character

 Normal: The normal apex beat gently lifts the palpating fingers

 

Heaving: apex beat is a forceful and sustained impulse. lifting the examining finger (pressure overload). It indicates left ventricular hypertrophy (LVH). Causes are hypertension and AS

 

Mechanism: In order to compensate for the increased pressure load on the left ventricle, the ventricle enlarges in size, making it more likely to be palpable. In conditions of increased afterload, ejection of blood out of the left ventricle is prolonged throughout systole, giving the impression of a sustained impulse through to S2.

 

Thrusting: Apex beat is a displaced, diffuse, non-sustained impulse (Volume overload). Also called hyperkinetic or dyskinetic apex. It indicates left ventricular dilatation (found in MR and AR) or DCM.

 

Mechanism: In volume-overloaded states, the Frank–Starling mechanism produces a more forceful ventricular contraction.

 

Tapping: Tapping apex: Neither sustained nor forceful, not lifting the finger. It is the palpable first heart sound. Found in MS (rarely TS).

 

Mechanism: One suggested mechanism is that reduced ventricular filling caused by stenosis over the mitral valve results in a shortened outward movement of the apex, which creates the short, sharp tapping quality

 

 

The double impulse apex beat, where two distinct impulses are felt with each systole, is characteristic of hypertrophic cardiomyopathy