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Palpate the apex beat
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Feel for the pulsation which is outer most and down most where the pulsation is felt distinctly
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Measure the position – the space by counting down from the second intercostal space which lies below the sternal angle
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Measure laterally in centimeters from the middle line
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Describe the apex beat in relation to the mid clavicular line.
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Important – normal position of apex beat is in the fifth left intercostal spaceZ just inside or on the mid clavicular line
Apex beat
Assess the character
- Normal
- Tapping – in mitral stenosis
- Heaving (when pressure overload) – aortic stenosis, hypertension
- Thrusting (when volume overload) – mitral or aortic incompetence
- Impalpable – obesity, COPD (Chronic Obstructive Pulmonary Disease), pericardial effusion
Palpate firmly the left border of the sternum - Use the flat of your hand – a left sternal heave suggest right ventricular hypertrophy - Palpate right sternal border, base of the heart with flat of hand for thrills (palpable murmers)