Apex beat

This presentation is about apex beat and its abnormalities.

1. بسم الله الرحمن الرحیم

2. A pex Beat Definition and Abnormalities

3. Definition Apex beat is the lowermost and outermost point of definite cardiac pulsation. Also known as "point of maximum impulse".

4. Normal Apex Beat Left ventricle normally produces the apex beat. Site of the apex beat With the patient in supine or sitting posture, it is located 1 cm medial to the midclavicular line or 9-10 cm from the mediastinal line, in the fifth left intercostal space. With the patient lying on his left lateral side, the apex beat may move 1-2 cm laterally. Features of the normal apex beat It is palpable only during the first half of systole and lasts less than 30% of systole. On palpating the carotid artery simultaneously , the apical beat does not last longer than the carotid upstroke. It gently raises the palpating finger. It is detectable in only one intercostal space and is less than 3 cm in diameter.

5. Abnormalities of Apical Impulse Abnormalities in character Abnormalities in position Abnormalities in Character Hyper dynamic apex Heaving apex Tapping apex Hypokinetic apex Double apex

6. Hyper dynamic Apex (Hyperkinetic Apex; Volume Overload Apex; Diffuse Apex; Forceful and Ill-Sustained Apex ) Site of the apex beat Shifted downwards and laterally due to chamber enlargement resulting from volume overload Features of the hyper dynamic apex beat: The apical thrust is increased in amplitude. It lifts the finger up, but the lift is not sustained. It lasts more than 30% but less than 60% of systole. It is detectable in more than one intercostal space and is more than 3 cm in diameter.

7. • Conditions associated with hyper- dynamic apex beat Increased left ventricular stroke volume (volume overload) Dilated cardiomyopathy • Aortic regurgitation • Mitral regurgitation • Ventricular septal defect • Patent ductus arteriosus Dilated cardiomyopathy Hyper dynamic circulatory states • Exercise • Thyrotoxicosis • Severe anemia

8. Heaving Apex (Sustained Apex; Pressure Overload Apex; Forceful and Sustained Apex) Site of the apex beat Usually normal in position and results from left ventricular hypertrophy due to pressure overload. Features of the heaving apex beat The apical thrust is increased in amplitude and duration. The duration of the thrust is prolonged and felt in the second half of systole also. It lasts more than 60% of systole. It lifts the finger up and the lift is sustained. It is detectable in only one intercostal space and is less than 3 cm in diameter.

9. • Conditions associated with heaving apex beat (pressure overload of left ventricle ) • Aortic stenosis • Systemic hypertension • Coarctation of aorta • Hypertrophic cardiomyopathy

10. Tapping Apex It is due to palpable loud first heart sound. It imparts a tapping feeling to the palpating finger. Occurs in mitral stenosis.

11. Hypokinetic Apex or Absent Apical Impulse • Obesity • Pericardial effusion • Emphysema • Constrictive pericarditis • Shock • Myxedema

12. Double Apex Occurs in hypertrophic cardiomyopathy and left ventricular aneurysm . Abnormalities in Position- Causes Cardiac enlargement • Aortic regurgitation • Mitral regurgitation • Ventricular septal defect • Patent ductus arteriosus • Dilated cardiomyopathy Cardiac displacement • Scoliosis, funnel chest Pulmonary diseases • Pulmonary fibrosis • Collapse of lung • Large pulmonary masses Dextrocardia Pleural diseases • Pleural effusion •Pneumothorax •Hydro pneumothorax •Pleural fibrosis