Localising the Apex beat
- Ask the patient to lie supine on the bed
- Stand on the right side of patient
- Place your hand over the left side of chest over the lower sternum such that the fingers of your hand spread at the intercostal spaces.
- Feel for the maximal impulse
- If unable to feel, ask the patient to lean forward.
- If still unable to feel the impulse, then place your hand on the right side of the chest at the level of lower sternum to rule out Dextrocardia.
- Remember – the patient should lie flat and never towards any lateral side as it can displace the apex beat
Normal position of the apex beat is 5th intercostal space at the left side, at the midclavicular line
Variation in apex beat
The position of apex beat can occasionally give a clue of the anatomical changes.
If apex is outwards- Think Right Ventricular Hypertrophy
If downwards and outwards- Left Ventricular Hypertrophy