Apical impulse

The right hand is positioned in the projection of the proposed push, between the 3rd and 6th rib in the region of the apex of the heart. The pulsation is determined by the entire palmar surface, and then localized by the tip of the index finger. It must be installed perpendicular to the chest. With widespread pulsation, its leftmost and lower region is determined.

If it is difficult to feel the apical impulse of the heart due to the peculiarities of the chest, then palpation is carried out with the chest cell tilted forward, or the patient is placed on the left side. The heart muscle in these positions tightly adjacent to the chest and moves the edge of the left lung.

In the position on the left side, the heart beat falls lower and to the left on 2 cm, so the intercostal space where the contraction is determined is taken as the push point, but on the 2 cm is more medial from the push area. Palpation of the apical impulse during exhalation increases the chances of determining its location, because when the diaphragm is raised, the heart, making a pendulum-like movement to the left and up, changes to a more horizontal position, moving the edge of the left lung back.

Doctors determine certain properties of the heart shock:

Abbreviations of the apex of the heart form a heart beat. The tip lies slightly medial to the mid-clavicular line, in the 5 intercostal space on the left. It is relatively free and makes pendulum movements. If the position of the body changes, the location of the jolt is shifted. Some variants of push displacement have been described above.

When a person turns to the right side of the pronounced shift of the area of ​​the atrial pulsation does not occur, and the left lung, at this time, approaching the heart, can completely move him away from the chest wall. Therefore, normally, on the right side, the atrial pulsation can almost disappear.

Pulsation offset is divided into two types:

  1. Displacement not associated with cardiac pathology (pneumothorax, hydrothorax, wrinkling of the lung, emphysema, altered level of the diaphragm – ascites, pregnancy, flatulence, emaciation)
  2. Pathological pulsation associated with cardiac pathology.

In the latter case, the shift occurs to the left due to an increase in the left ventricle, sometimes to the anterior axillary line, and down to the 6,7,8 intercostal space. The expansion of the right ventricle also gives the displacement of the border of the heart to the left, but the impulse remains in the 5 intercostal space.

The protrusion of the cardiac impulse is about 2 cm². If it turns out to be greater, then they talk about a spilled or widespread impetus. With a smaller area, it is limited.

In the absence of these states, a spilled push can result from the expansion of the heart (of all or any of its parts).

Diagnostic significant pulsations are the pulsation of the aorta, pulmonary artery and epigastric pulsation. The first of them is invisible in the norm. Pathological pulsation appears in the second intercostal space on the right at the edge of the sternum. The reasons for its occurrence include:

  • wrinkling of the right lung;
  • aortic enlargement (syphilis, ascending aortic aneurysm, aortic valve defects).

The pulsation of the pulmonary artery (II intercostal space to the left of the sternum) is the result of pulmonary hypertension in mitral valve defects.

A cardiac impulse is an oscillation in a limited area of ​​the chest in the region where the heart is located, caused by the contraction of the organ and is an external manifestation of its activity.

The altered shape and size of the heart when it is stressed leads to fluctuations at the moment of contact of the top of the heart with the chest.

During the period of diastole (relaxation) of the ventricles, the heart decreases in size and is somewhat removed from the sternum, which leads to the disappearance of protrusion.

The determination of a heart beat occurs with the help of examination and palpation and precedes listening to the sounds made by him.

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Properly performed percussion is also a fairly informative method, but at the moment it is practically not used.

To examine the patient by cardiography, specialists resort to a specular Frank cardiograph

However, the results of cardiography in determining a cardiac impulse may not always be accurate and depend on the different projection of the impulse onto the chest, the thickness of the subcutaneous layer, the perceiving properties of the apparatus, etc.

Visual inspection and palpation are suitable exclusively for detecting apical impulse. It occurs when the left ventricle and interventricular septum move towards the chest.

Additional cardiac tremors are possible with pathological changes in the ventricles, atria and large vessels. It is important to systematically find this symptomatology.

Visual examination of the patient is the initial stage of the study of cardiac activity and in some cases is more effective than palpation.

It should be noted that for some features of the human body, visual observation of the shock may be absent, for example:

  • overweight;
  • small gaps between the ribs;
  • developed muscles;
  • large mammary glands or implants in them.

In people with asthenic physique, vibrations are most pronounced.

Palpation is a diagnostic method, carried out by palpating tissues and organs with your hands. The examination has no contraindications and is used for all categories of patients

After the examination, they proceed to the palpation method, which includes the following actions:

  • The location of the right hand in the area of ​​the proposed shock (between 3 and 6 ribs of the upper part of the organ).
  • Initially, the pulsation is determined by the entire palm with further localization by the index finger (pad).
  • A common ripple involves determining its extreme left area in the lower part. In this place, the impulse actually appears.

The most effective is palpation when the patient bends or is lying on his left side after a deep exhalation. If a person is located on the right side, the left lung moves the heart away from the chest, making it impossible to listen to tremors.

Examination of women involves raising the left breast.

As a result, under the finger there is a sensation of rhythmic vibrations that occur when the left ventricle strikes the chest.

Next, the specialist analyzes the results obtained by palpation and the need for additional examination of the patient.

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Push localization

5c22b629ad9baee3da75a96f61000271 - Apical impulse

The apex of the heart during contraction generates chest vibrations. The apex is quite loose and moves rhythmically. When moving the body, the position of the pendulum deviates accordingly.

Inspection and palpation of contractions of the right ventricle are impossible, because they do not lead to the appearance of visible and felt chest oscillations. In some cases, there is a weak palpation of the movements of the right ventricle in childhood or adolescence with small anteroposterior sizes of the chest.

The normal location of the shock is the fifth intercostal space 1-1,5 cm more medial than the left mamillary line.

Vibration displacement may indicate pathological processes in the body or be observed during pregnancy, flatulence, excessive weight loss.

Another article: The structure of the human heart

  • diseases, one of the symptoms of which is an enlarged left ventricle: aortic stenosis, hypertension, mitral valve insufficiency;
  • pushing the left ventricle to the left side with the right with enlarged dimensions of the latter;
  • filling the pleural cavity with fluid or air on the right side;
  • high standing of the diaphragm, which displaces the left ventricle to the left side during the period of bearing a child, with excess body weight, high gas content in the intestine, fluid accumulation in the abdominal cavity.
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Aortic insufficiency leads to a shift in the oscillations to the left and down.

A biased push to the right and down causes a low standing of the diaphragm, which can lead to emphysema and reduced body weight.

Exudative pericarditis and left-sided exudative pleurisy generally prevent heart tremors.

The area of ​​the heart beat should normally be 2 square meters. see Deviations from it may indicate pathology. As a rule, in a person lying on his left side, the ideal area is 1,8 square meters. cm.

Exceeding this indicator upwards indicates a spilled apical impulse, which is observed:

  • with enlarged heart, mainly the left ventricle;
  • thin chest;
  • wide intercostal spaces;
  • shriveled lower edge of the left lung;
  • forward displacement of the heart by neoplasms in the middle parts of the chest cavity;
  • high standing aperture.

Cardiomegaly can increase the area of ​​vibration of more than 4 cm.

Duration

In a normal state, the apical impulse does not differ in duration and extends to the middle of the systole. Longer vibrations are considered pathological and require a more detailed medical examination.

As a rule, an increase in the duration of vibration is caused by an increase in the heart, or an increased load on it with both pressure and volume.

If pathological noises are absent, the development of cardiomegaly or a decrease in the volume of blood pushed by the left ventricle into the aortic lumen during systole is possible.

AgeBefore 2 years2 – 7 years7 – 12 years
Push localization1 – 2 cm outwards from the left midclavicular line1 cm outward from the left midclavicular lineOn the mid-clavicular line or 0,5 – 1 cm inward from it
4 intercostal space5 intercostal space
    Pay attention to:
  • Skin color (normal color/pallor/cyanosis)
  • The presence of pulsation of the carotid arteries, dancing carotids (expansion and contraction of the pupils and also small head nods to the beat of the pulsation)
  • The presence of swelling of the yarmine veins (may be a variant of the norm in children when moving to a horizontal position)
  • The shape of the chest – the presence of a cardiac hump (protrusion in the projection of the heart)
  • The severity of the apical impulse
  • Heart beat
  • The severity of epigastric pulsation
  • The presence of edema on the legs (“cardiac edema), in the sacral region
  • The presence of finger deformation (“drumsticks”)
  • Heart beat height

    The height of the heart beat is the amplitude of the pulsating portion of the chest. Distinguish high, low and normal cardiac impulse. The reasons for low are the same as for limited. Accordingly, the causes of the spilled form a high apical impulse. It also occurs with tachycardia, due to thyrotoxicosis, fever, in smokers, with severe stress.

    A resistant cardiac impulse is a pulsation that gives the sensation of a thick, dense muscle on palpation, which is difficult to give in to pressure. So, if it is also diffuse, strong in nature, then it is defined as a dome-shaped apical impulse. Normally, it is not defined, but is formed during aortic defects or hypertension, when left ventricular hypertrophy develops.

    Conclusion

    The above research methods are important for the practitioner, however, due to the development of hardware diagnostics, doctors’ commitment to the definition of pathology through examination and palpation has decreased significantly over the past decades.

    However, the need to continue the above practice is very great. Professionals determining the apical impulse by palpation should be encouraged and more actively disseminated information about the application of this method in medicine.

    In many cases, the use of palpation has led to positive results, including the early diagnosis of the disease. The apical impulse determined by a specialist (in normal conditions and in various pathologies) is a serious indicator for establishing methods of treating patients.

    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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