The pulse reflects the heart’s pumping action as blood moves through arteries. While commonly felt at the wrist or neck, the apical pulse offers a direct and often more accurate measurement of heart function. Unlike peripheral pulses, the apical pulse directly assesses the contractions of the heart’s left ventricle, which pumps oxygenated blood to the body. This direct connection makes it a valuable indicator of cardiovascular health.
Locating the Apical Pulse
Measuring the apical pulse requires a stethoscope and a watch with a second hand. For adults, the most accurate location is the fifth intercostal space (between the fifth and sixth ribs) at the midclavicular line (an imaginary line running vertically down from the middle of the collarbone). This point is also known as the point of maximal impulse (PMI), where the heart’s beat is most easily felt or heard.
To find this location, position the individual lying down or sitting comfortably. Locate the sternal notch at the top of the breastbone, then move down to the “angle of Louis,” a slight protrusion where the manubrium meets the sternum. The second rib extends from this angle. Gently slide your fingers down the left side of the sternum, counting intercostal spaces until you reach the fifth space. Then, move your fingers horizontally to the midclavicular line.
Once identified, place the stethoscope’s diaphragm firmly but gently over this spot. Listen for the “lub-dub” sounds, representing one complete heartbeat. For a precise measurement, especially if irregular, count the beats for a full minute. For infants and young children, the apical pulse is slightly higher, at the fourth intercostal space at the left midclavicular line. If the individual has larger breasts, they may need to gently lift the tissue for direct stethoscope placement.
When to Measure the Apical Pulse
The apical pulse is measured when other pulse points might not provide a clear or accurate reading. It is preferred for assessing heart rate in infants and young children, as their peripheral pulses can be difficult to locate and count. This measurement is also important for individuals with very weak or irregular peripheral pulses, as it offers a direct assessment of the heart’s actual contractions.
Healthcare professionals frequently measure the apical pulse during cardiac examinations, especially if a person reports symptoms like chest pain, shortness of breath, fatigue, or an irregular heartbeat. It is also a routine assessment before administering certain cardiac medications, such as digoxin, which can affect heart rate and rhythm. Monitoring the apical pulse helps evaluate treatment effectiveness and safety. For people with obesity, where peripheral pulses can be challenging to palpate, the apical pulse provides a more accessible and reliable measurement.
Understanding Your Apical Pulse
Once measured, the apical pulse rate, rhythm, and strength provide information about heart function. For a healthy adult, a resting apical pulse falls between 60 and 100 beats per minute (bpm). Highly conditioned athletes may have a lower resting heart rate, sometimes 40 to 60 bpm. Children generally have higher resting pulse rates than adults, with ranges varying by age. For example, newborns may have a pulse between 70 and 190 bpm, which gradually decreases as they grow.
A normal apical pulse exhibits a regular rhythm, meaning beats occur at a consistent tempo with even intervals. An irregular rhythm, where beats are unevenly spaced, can suggest an arrhythmia or other underlying heart condition. Factors like physical activity, anxiety, fever, pain, and certain medications can influence the apical pulse rate. A consistently high or low apical pulse, or any significant irregularities, indicates a need for further medical evaluation. Consult a healthcare professional for any concerns regarding your apical pulse.