The apical pulse, also known as the point of maximal impulse (PMI), is the pulse felt directly over the heart’s apex. This measurement directly reflects the heart’s activity, specifically the contraction and relaxation of the left ventricle. Unlike arterial pulses, the apical pulse allows for direct listening to the heart as it pumps blood. It indicates cardiac health and is a vital sign.
Locating the Apical Impulse
Identifying the apical impulse requires understanding anatomical landmarks on the chest. In most adults, it is found in the fifth intercostal space, between the fifth and sixth ribs. This location aligns with the midclavicular line, an imaginary vertical line extending downwards from the midpoint of the collarbone. This area is significant because the heart’s apex lies closest to the chest wall here, making pulsations discernible.
To find this spot, start by locating the sternal notch at the top of the breastbone, then move down to the “angle of Louis,” a bony ridge where the manubrium meets the sternum. The second rib extends from this angle, providing a starting point for counting downwards. Count five rib spaces down along the left side of the chest, then move horizontally to align with the midclavicular line. Gentle palpation can help identify the slight pulsation.
Technique for Assessing Apical Pulse
Assessing the apical pulse accurately involves a systematic approach, requiring a stethoscope and a watch with a second hand. The individual should be positioned comfortably, either lying flat on their back or sitting upright. If lying down, rolling slightly onto their left side can bring the heart closer to the chest wall, making the pulse easier to hear.
Once the apical impulse location is identified, place the stethoscope’s diaphragm directly onto the bare skin over this area. Ensure a complete seal for clear sound transmission. Listen for the characteristic “lub-dub” sounds, representing one complete heartbeat. For a thorough assessment, especially if irregularity is suspected, count the beats for a full minute to determine the heart rate.
When Apical Pulse Assessment is Crucial
Apical pulse assessment is important in several clinical situations. It is often the preferred method for assessing heart rate in infants and young children, as their peripheral pulses can be challenging to palpate accurately. For children under seven, the apical pulse is typically found in the fourth intercostal space at the midclavicular line. This assessment is also important for individuals with known or suspected irregular heart rhythms, such as atrial fibrillation, where peripheral pulses might not accurately reflect the actual heart rate.
The apical pulse is frequently assessed when peripheral pulses are weak, difficult to find, or absent due to circulatory conditions. It is also a standard procedure before administering cardiac medications that affect heart rate and rhythm, allowing monitoring of effects and ensuring patient safety. This direct assessment provides a more reliable measure of the heart’s electrical and mechanical activity.
Interpreting Apical Pulse Findings
Interpreting apical pulse findings involves evaluating the rate, rhythm, and character of the heartbeat. For most adults at rest, a normal apical pulse rate ranges from 60 to 100 beats per minute. This range can vary based on factors like age, fitness level, and medical conditions; for example, children typically have higher normal heart rates than adults. The rhythm should generally be regular, with consistent intervals between beats.
A very fast rate (tachycardia) or a very slow rate (bradycardia) can indicate underlying health issues. An irregular rhythm might suggest an arrhythmia, an abnormal heart rhythm. The strength and duration of the apical impulse can also provide clues about heart function, with a prolonged or forceful impulse potentially indicating conditions affecting heart size or pressure. Any consistently abnormal findings warrant further medical consultation for proper diagnosis and management.