The apical pulse represents the heart’s true beat, directly reflecting the contractions of the left ventricle. Finding and feeling this pulse provides valuable insight into heart function. Understanding its location and how to palpate it can be beneficial for monitoring heart health.
Understanding the Apical Pulse
The apical pulse, also known as the Point of Maximal Impulse (PMI), is the heartbeat felt at the heart’s apex. This pulsation originates from the contraction of the left ventricle. It is considered the most accurate measure of heart rate because it directly reflects the heart’s actual contractions, unlike peripheral pulses that can be affected by factors like blood vessel constriction or weakness.
Locating the Apical Pulse
To find the apical pulse in adults, identify specific anatomical landmarks on the chest. Begin by locating the sternal notch, the indentation at the top of the breastbone. Slide your fingers down the breastbone until you feel a horizontal ridge, the Angle of Louis or sternal angle. This angle marks the location of the second rib.
From the second rib, count downwards along the left side of the chest, feeling for the spaces between the ribs, known as intercostal spaces. The apical pulse in adults is typically located in the fifth intercostal space. Next, locate the midclavicular line, an imaginary vertical line that extends straight down from the middle of the left collarbone. The apical pulse is generally found where the fifth intercostal space intersects with this midclavicular line. For infants and young children, the heart’s position is slightly different, and their apical pulse is usually found in the fourth intercostal space at the midclavicular line.
The Palpation Process
Once the approximate location is identified, begin palpation. The individual should ideally be lying flat on their back or comfortably seated. Turning slightly to their left side can bring the heart closer to the chest wall, making the pulsation easier to feel. Gently place the pads of your fingertips, usually your index and middle fingers, over the estimated apical pulse site.
Apply light pressure; too much pressure can obscure the pulsation. Feel for a gentle, rhythmic tap. Each distinct tap represents one heartbeat. To obtain an accurate heart rate, count the pulsations for a full minute, especially if the heart rhythm feels irregular.
Significance and Common Variations
The normal apical pulse rate for most resting adults ranges from 60 to 100 beats per minute. Athletes may have a lower resting heart rate, sometimes between 40 and 60 beats per minute. Children typically have higher resting heart rates, which gradually decrease with age.
A notable difference between the apical pulse and a peripheral pulse, such as the one felt at the wrist, is called a “pulse deficit.” This occurs when the apical pulse rate is higher than the peripheral pulse rate, meaning some heartbeats are not strong enough to create a detectable wave in the arteries further from the heart. A pulse deficit can indicate issues with heart efficiency or conditions like an irregular heartbeat.
The apical pulse can sometimes be challenging to locate in individuals with obesity or certain lung conditions. In such cases, repositioning the person or using a stethoscope for auscultation may be necessary. The apical pulse is particularly useful for assessing heart rate in infants, where peripheral pulses are difficult to feel.