Physical examination maneuver
Physical Exam
Point of Maximal Impulse
also known as Apical impulse; apex beat
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How to Perform
With the patient supine and the precordium exposed, palpate the left precordium with the finger pads to locate the apical impulse, which is typically in the fifth intercostal space near the midclavicular line. Once identified, define its borders and assess its location, diameter, amplitude, and duration. If the apical impulse is not readily palpable, ask the patient to roll into the left lateral decubitus position and repeat the examination.
How to Interpret
Showing 6 of 19 findings
Aortic Stenosis
Apical-carotid delay in a patient with known aortic stenosis
Rule in
Very helpfulWide CI
Rule out
Very helpfulDerived CI
Evidence:Moderate
Cardiomegaly
Laterally displaced PMI
Rule in
Somewhat helpfulNo CI
Rule out
Minimally helpfulNo CI
Evidence:ModerateResearch in progress
Hypertrophic Cardiomyopathy
Double (bifid) apical impulse
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Left Ventricular Dilation
Diffuse PMI (apical diameter >3 cm in left lateral decubitus)
Rule in
Very helpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate
Left Ventricular Hypertrophy
Sustained or double PMI
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Reduced Left Ventricular Ejection Fraction
Laterally displaced PMI, supine
Rule in
Very helpful
Rule out
Minimally helpfulNo CI
Evidence:Strong
Related Bedside Tests
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
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Carotid Artery Palpation
Rule in:HAortic Stenosis, HTakayasu Arteritis, IEAcute Aortic Dissection +9 more
Rule out:SHAortic Stenosis, NHTakayasu Arteritis, IEAcute Aortic Dissection +9 more
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Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
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Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
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Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
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Brachial Artery Palpation
Rule in:IEAortic Regurgitation, IEAortic Stenosis, IEReduced Left Ventricular Ejection Fraction
Rule out:IEAortic Regurgitation, IEAortic Stenosis, IEReduced Left Ventricular Ejection Fraction