The apical pulse is the heartbeat, heard directly from the heart, offering a precise measurement of heart rate. This direct assessment is highly accurate as it captures the heart’s contractions as they occur. Unlike other pulse points felt through arteries, the apical pulse provides a clear indication of cardiac activity. Its accuracy makes it valuable for understanding heart function.
What is the Apical Pulse and Why Measure It?
The apical pulse is located at the apex of the heart, which is the lower, pointed end of the left ventricle. In most adults, this site is typically found on the left side of the chest, specifically in the fifth intercostal space (the gap between the fifth and sixth ribs) at the midclavicular line, an imaginary line extending straight down from the middle of the collarbone. For children younger than seven, the apical pulse is usually located slightly higher, at the fourth intercostal space.
Measuring the apical pulse offers advantages over peripheral pulses, such as those felt at the wrist or neck. Peripheral pulses reflect the pressure wave of blood moving through arteries, which can be less accurate if heart contractions are weak or irregular. The apical pulse allows direct listening to the heart’s “lub-dub” sounds, providing an assessment of its rate, rhythm, and strength. This method is often preferred for infants and young children, whose peripheral pulses can be difficult to palpate accurately. It is also used when an individual has an irregular heart rhythm, takes certain cardiac medications, or when other pulse points are weak or unpalpable.
Measuring Your Apical Pulse: A Step-by-Step Guide
To measure the apical pulse, you will need a stethoscope and a timer. Begin by ensuring the individual is in a comfortable position, ideally lying flat on their back or slightly turned to their left side. This positioning helps bring the heart closer to the chest wall, making the pulse easier to locate and hear.
Next, locate the apical impulse. For adults, identify the sternal angle, the bony ridge where the top of the breastbone meets its main body. Move your fingers to the right or left of this angle to find the second intercostal space.
From there, gently slide your fingers down the chest wall, counting each rib and the space below it, until you reach the fifth intercostal space. Once the fifth intercostal space is identified, move your fingers horizontally along this space until you are directly beneath the middle of the left collarbone, marking the midclavicular line. This point is where the apical impulse is most pronounced.
Place the stethoscope’s diaphragm firmly but gently on the bare skin over this location. Ensure the environment is quiet to minimize external sounds that could interfere with hearing heart sounds. Listen for the “lub-dub” sounds, which represent one complete heartbeat. Count each “lub-dub” as a single beat for 60 seconds to ensure an accurate reading, particularly if the rhythm appears irregular. While listening, observe the regularity of the beats, noting if they are evenly spaced or if any pauses or skips occur.
Understanding Your Apical Pulse Reading
Once measured, the apical pulse rate provides insight into heart function. Normal resting apical pulse rates vary with age. For adults, a typical resting heart rate ranges from 60 to 100 beats per minute (bpm). Well-trained athletes may have a lower resting rate, between 40 and 60 bpm.
For children, heart rates are generally higher and decrease with age. For instance, newborns (0-1 month) typically have a rate between 70-190 bpm, while infants (1-11 months) range from 80-160 bpm. Children aged 1-2 years often fall between 80-130 bpm, and those 3-4 years old between 80-120 bpm.
An irregular rhythm, where beats are not evenly spaced, can indicate an issue with the heart’s electrical activity. Conditions such as atrial fibrillation can manifest as an uneven apical pulse. If the apical pulse rate is consistently outside the typical range for your age group, or if you detect a significant irregularity, consult a healthcare professional. This is especially true if such readings are accompanied by symptoms like dizziness, chest pain, shortness of breath, or unusual fatigue. Measuring your apical pulse is a monitoring tool; these findings should always be discussed with a medical provider for interpretation and guidance.