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  1. Hyper dynamic apical impulse
    1. Seen in volume overload
    2. Seen as forceful and sustained beats in left ventricular diastolic overload
    3. Conditions associated
      1. Mitral regurgitation
      2. Aortic regurgitation
      3. VSD
      4. PDA
  2. Heaving apical impulse
    1. Seen as forceful and well sustained heave
    2. Generally seen in pressure overload of left ventricular
    3. Conditions associated
      1. Aortic stenosis
      2. Systemic hypertension
      3. Coarctation of aorta
      4. Obstructive cardiomyopathy
  3. Tapping apex beat
    1. Denotes loud first heart sound
    2. Seen in Mitral stenosis
  4. Hypokinetic apex beat
    1. Seen in
      1. Pericardial effusion
      2. Constrictive pericarditis
      3. Myocardial infarction

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