This article discusses how to locate and interpret the apical pulse.
How to Check Apical Pulse
Other pulse sites are felt by placing the finger over a medium or large artery.
The apical pulse, on the other hand, is a more direct way to feel the pulse, since you can directly feel the left ventricle’s contraction at this site. With each heartbeat, blood is ejected out of the left ventricle into the blood vessels to carry oxygen and nutrients throughout the body.
The best position to find the apical pulse is to lay down on your left side with your head resting on your left arm. Then:
With the palm side of your right arm, locate the center of the collarbone (clavicle) and bring your hand down about five rib spaces. Although breast anatomy varies, the apical pulse location is typically located below and to the left of the nipple. You may need to move breast tissue aside to locate the apical pulse. The pulse location may vary as your lungs fill with air while breathing, so it can be helpful to palpate the area after exhaling fully. Once you locate the area with your hand, try to use just the pointer and middle finger to narrow down the area, known as the point of maximal impulse (PMI). Notice the size of the area, the rate of the pulse, and how many impulses you feel with each heartbeat. Count the pulse for a full minute for the best accuracy.
Advantages of This Pulse Site
While other pulse sites give information about heart rate and heart rhythm, they are located further away from the heart, so what you’re feeling is the blood vessels filling with blood from the heart’s contraction.
Carotid pulse: Felt in the neck to the side of the trachea (windpipe) Radial pulse: Felt just below the wrist on the side nearest the thumb Brachial pulse: Felt in the flexor crease of the elbow Femoral pulse: Felt in the groin Popliteal pulse: Felt behind the knee Dorsalis pedis pulse: Felt on the top side of the foot, about midway between the ankle crease and the space between the first and second toes Posterior tibialis pulse: Felt in the inner ankle just behind the ankle bone
These pulse sites are important because they may be easier to feel, and they can also indicate problems with blockages in blood vessels. For example, pulses in the leg, which include the popliteal, dorsalis pedis, and posterior tibialis pulses, may be diminished or absent in peripheral artery disease.
When feeling the apical pulse, you are directly feeling the contraction of the heart itself. Some advantages of the apical pulse site include the ability to gain information about the size and location of the heart, as well as potential abnormalities in the heart.
Results
Location
The location of the apical pulse can vary in the following circumstances:
Pregnancy Mass in the chest that causes displacement of the heart Enlarged heart Thickened heart muscle Dextrocardia, a rare condition in which the heart is located on the right side of the chest
Target Ranges
You can use the apical pulse to calculate the heart rate in beats per minute (bpm). Count the number of beats in 15 seconds and multiple by four to get bpm. Or, count for a full minute for better accuracy.
At rest, 60-100 bpm is considered a normal heart rate. In some cases, a heart rate below 60 or above 100 can still be normal.
Apical Pulse Size
The size of the apical pulse should be no larger than a dime. A larger area can indicate an enlargement of the heart, such as a cardiomyopathy.
Apical Pulse Duration and Force
The apical pulse should feel like a tapping movement.
A prolonged impulse can be a sign of pressure overload on the heart, such as with high blood pressure or a narrowed aortic valve (aortic stenosis). In these cases, the heart must pump against a higher pressure to eject blood. A forceful apical pulse can be a sign of valve leaking (aortic regurgitation or mitral regurgitation).
Extra Apical Pulse
In a structurally normal heart, the apical pulse should have a single impulse with each heartbeat. Feeling two or three impulses with each heartbeat can indicate abnormalities in the heart’s structure.
For example, those with hypertrophic cardiomyopathy, which causes thickening of a portion of the heart muscle, may feel a double or triple impulse.
People with problems of the aortic valve that result in severe regurgitation may feel a double impulse.
Factors That Affect Apical Pulse
The apical pulse can be affected by things that alter the size of the heart and the way that blood moves in and out of the heart, including:
Cardiomyopathy, or heart muscle problemsValve problems such as narrowed (stenotic) or leaky (regurgitant) valvesHeart rhythm abnormalities
When to See a Healthcare Provider
Any abnormalities in your pulse should be discussed with a healthcare provider. By feeling your pulse and listening with a stethoscope, your healthcare provider can confirm if an abnormality exists.
Advancing age High blood pressure Other types of heart abnormalities, such as heart valve problems Obstructive sleep apnea Alcohol use
Further studies like heart imaging tests or heart rhythm tests may be recommended.
Summary
The apical pulse is an important pulse site that can provide information about heart size, location, rate, and rhythm. It is located on the left side, down five rib spaces from the middle of the collarbone.
Some structural heart abnormalities, such as cardiomyopathy and valve problems, can cause characteristic findings in the apical pulse. If you discover abnormalities in your pulse rate, discuss them with your healthcare provider.
A Word From Verywell
Some people may have difficulty locating their apical pulse, but don’t be discouraged if you can’t. Apical pulse is just one way to measure your heart’s functioning. If you experience pulse abnormalities, contact your healthcare provider to discuss possible causes.
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