On precordial palpation, rapid apical impulse
On physical examination, his apical impulse was displaced to the left and pulmonary sounds were decreased in the left lower zone with some bronchial rales.
Displacement of the apical impulse into the mid axillary line as in our patient (1,5,6) and recurrent pulmonary infections which was also seen in the bronchiectatic patient was described with the pericardial absence (2).
The apical impulse is sustained non displaced and diffuse; often bifid as a result of a palpable $4.
Apical impulse is hyperdynamic and displaced downward and laterally signifying LV dilatation and hypertrophy.
As you feel that apical impulse
, it will be of increased intensity.
Physical findings that may support a diagnosis of heart failure include raised jugular venous pressure, peripheral edema not due to venous insufficiency, presence of a third heart sound, gallop rhythm, laterally displaced apical impulse
, tachycardia, and pulmonary rales that do not clear with coughing.
CVS examination revealed apical impulse
well defined in left fifth intercostal space 1cm lateral to mid clavicular line, variable S1, loud P2, systolic murmurs in mitral and tricuspid areas.
Finding a displaced apical impulse
was especially useful, and is a diagnostic skill that is often neglected in a busy setting.
On cardiac examination, diffuse apical impulse
was found in 6th ICS just lateral to midclavicular line and there was grade-1 left parasternal heave.