Cardiac apical impulse is normally localized at the fifth intercostal space, midclavicular line. Abnormalities include:

  • Forceful apical thrust: Left ventricular hypertrophy
  • Lateral and downward displacement of apex impulse: Left ventricular dilatation
  • Prominent presystolic impulse: Hypertension, AS, hypertrophic cardiomyopathy
  • Double systolic apical impulse: Hypertrophic cardiomyopathy
  • Sustained “lift” at lower left sternal border: Right ventricular hypertrophy
  • Dyskinetic (outward bulge) impulse: Ventricular aneurysm, large dyskinetic area post MI, cardiomyopathy

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