The apical pulse is located on the left side of your chest, between the fifth and sixth ribs, along an imaginary vertical line that runs down from the middle of your collarbone. This spot, known as the fifth intercostal space at the left midclavicular line, is where the bottom tip of your heart sits closest to the chest wall. It’s the strongest point where a heartbeat can be heard with a stethoscope or, in many people, felt with a fingertip.
Finding the Exact Spot
To locate the apical pulse, you need two landmarks: a rib space and a vertical line. Start by finding your collarbone on the left side and imagining a line dropping straight down from its center. That’s the midclavicular line. Next, count down from the top of your ribcage to the space between the fifth and sixth ribs. Where those two references meet is the apical pulse point.
This location is also called the point of maximal impulse, or PMI. The name is literal: it’s the spot on the chest wall where the heart’s beating produces the strongest push outward. That impulse comes from the left ventricle, the heart’s main pumping chamber, contracting during each heartbeat. In a person with a normally sized heart, the PMI and the apical pulse are the same spot.
Why It Differs in Children
In children under age 7, the apical pulse sits higher on the chest. Their heart’s apex is located in the fourth intercostal space, between the fourth and fifth ribs, rather than the fifth. As the chest grows and the heart shifts downward, the pulse point migrates to the adult position. If you’re checking a young child’s heart rate, counting one rib space too low could put the stethoscope in the wrong place entirely.
What a Shifted Location Can Mean
The apical pulse doesn’t always stay where it’s expected. When the left ventricle enlarges, whether from long-standing high blood pressure, heart valve disease, or other conditions, the heart’s tip gets pushed further to the left. A healthcare provider who finds the PMI noticeably outside the midclavicular line, or spread over a wider area than the usual quarter-sized spot, treats that as a physical sign worth investigating. The shift itself isn’t something you’d feel, but it’s one reason a provider presses their fingers against your chest wall during a cardiac exam before even reaching for a stethoscope.
How the Apical Pulse Is Measured
Checking an apical pulse requires a stethoscope. You can lie on your back or sit upright, with the left side of the chest exposed. The flat side of the stethoscope (the diaphragm) is placed directly over the PMI. A normal heartbeat produces two distinct sounds per beat, often described as “lub-dub.” Each lub-dub pair counts as one beat.
The standard is to listen for a full 60 seconds. This matters because shorter counts can miss irregular rhythms. If the beat is perfectly regular, a 30-second count multiplied by two gives an accurate rate, but the full minute is considered more reliable, especially when the rhythm seems uneven or when heart-related medications are involved. Normal resting heart rate for adults falls between 60 and 100 beats per minute.
Apical Pulse vs. Radial Pulse
Most routine pulse checks use the radial artery at the wrist because it’s quick and easy. The apical pulse provides something the wrist can’t: a direct listen to the heart itself. Every time the heart contracts, it should generate enough force to send a pulse wave all the way to the wrist. When the heart beats weakly or irregularly, some of those contractions may not produce a wave strong enough to feel at the radial artery.
The difference between the two counts is called a pulse deficit. If the apical rate is 90 beats per minute but only 72 of those beats reach the wrist, the deficit is 18. That means 18 times per minute, the heart contracted without effectively pushing blood to the rest of the body. A deficit greater than 10 typically warrants further evaluation, especially alongside symptoms like dizziness or fatigue. Checking for a pulse deficit involves listening to the apical pulse and feeling the radial pulse, ideally at the same time, then comparing the two counts over a full minute each.
When the Apical Pulse Is Preferred
Certain situations call for an apical reading over a wrist check. Infants and very young children have small, fast pulses that are difficult to count at the wrist, so the apical site is the go-to for accurate pediatric heart rates. People with irregular heart rhythms also benefit from apical assessment because it captures every contraction, including ones too weak to register at the wrist. The same applies before and after taking medications that directly affect heart rate or rhythm, where precision matters most.
Body size can make the apical pulse harder to locate. In people with larger chest walls, the impulse may not be easy to feel by touch alone, but a stethoscope placed in the correct intercostal space will still pick up the sound. Having the person lean slightly to the left or roll onto their left side can bring the heart closer to the chest wall and make the sounds clearer.