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Abnormal Apex Impulse

Updated: Sep 19, 2024

CLINICAL DIAGNOSTIC MANUAL



An abnormal apex impulse refers to a deviation in the location, intensity, or duration of the apical impulse of the heart, which is normally felt in the fifth left intercostal space at the midclavicular line.


This alteration can indicate various cardiac and extracardiac pathologies that affect the structure and function of the heart. Identifying and evaluating the apical impulse are crucial in the cardiovascular physical examination, providing valuable insights into the patient’s hemodynamic status.

Pathology

Suspected Diagnosis

Confirmatory Diagnosis

Interposition of fat, fluid, or air in the dermis

Displaced or non-palpable apical impulse, history of trauma or surgery.

Chest X-ray, echocardiogram, CT scan.

Dextrocardia

Apical impulse on the right side of the chest, thoracic asymmetry.

Chest X-ray, echocardiogram, CT scan.

Left ventricular hypertrophy

Displaced and sustained apical impulse, hypertension, dyspnoea.

Echocardiogram, ECG, blood tests.

Dilated left ventricle

Displaced and hyperdynamic apical impulse, dyspnoea, fatigue.

Echocardiogram, chest X-ray, CT scan.

Hypertrophic cardiomyopathy

Hyperdynamic and double apical impulse, dyspnoea, palpitations.

Echocardiogram, ECG, cardiac MRI (CMR).

Ventricular aneurysm

Hyperdynamic and sustained apical impulse, history of myocardial infarction.

Echocardiogram, CT scan, cardiac catheterisation.

Mitral stenosis

Hyperdynamic apical impulse, dyspnoea, diastolic murmur.

Echocardiogram, ECG, chest X-ray.

Right ventricular hypertrophy

Prominent left parasternal impulse, dyspnoea, cyanosis.

Echocardiogram, ECG, chest X-ray.


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