Physical Exam

Point of Maximal Impulse

also known as Apical impulse; apex beat

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Video coming September 2026

How to Perform

With the patient supine and then rolled into the left lateral decubitus position, palpate the precordium with the fingertips to locate the apical impulse — normally in the fifth intercostal space near the midclavicular line. Note its location, diameter, and character (amplitude and duration).

How to Interpret

Cardiomegaly

Laterally displaced point-of-maximal-impulse

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

Left Ventricular Dilation

Diffuse PMI

Rule in

Very helpful

Rule out

Very helpful

Evidence:Limited

Left Ventricular Hypertrophy

Sustained or heaving PMI

Rule in

Helpful

Rule out

Somewhat helpful

Evidence:Limited

References

Eilen SD, Crawford MH, O'Rourke RA. Accuracy of precordial palpation for detecting increased left ventricular volume. Ann Intern Med. 1983;99(5):628-630. doi:10.7326/0003-4819-99-5-628. PubMed: 6227265
O'Neill TW, Smith M, Barry M, Graham IM. Diagnostic value of the apex beat. Lancet. 1989;1(8635):410-411. doi:10.1016/s0140-6736(89)90004-4. PMID: 2563789. Free PubMed abstract.
Ehara et al. The clinical value of apex beat and electrocardiography for the detection of left ventricular hypertrophy from the standpoint of the distance factors from the heart to the chest wall: a multislice CT study. Hypertens Res. 2011. PMID: 21654756.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.