1. Ask the patient to lie supine on the bed
2. Stand on the right side of patient
3. 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.
4. Feel for the maximal impulse
5. If unable to feel, ask the patient to lean forward.
6. 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.
7. 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 5^th 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