Apical Impulse
Point of Maximal Impulse (PMI)
Normal = 5th intercostal space (ICS) along the left mid-clavicular line (MCL).
Area = 2cm to 3cm in diameter.
Character = nonsustained (brief <0.5 systole).
Examine the PMI placing the patient in the left lateral decubitus. Ask the patient to hold
his/her breath in full expiration.
Left ventricular Hypertrophy: Sustained (>0.5systole), wide and displaced (lateral and down)
apical impulse (Bard).
Impulses
Right Ventricular Hypertrophy (RVH) (under xiphoid process).
Hypertrophic Cardiomyopathy (HCM) (double systolic impulse).
Lifts
Pulmonary Artery : Systolic, 2nd ICS Left Sternal Border (LSB).
Pulsations
Pulmonary Artery: Over the right sternoclavicular joint.
THRILLS
Palpable, low frequency vibrations (rumbles, murmurs, snaps, gallops, knocks, etc).
Estimate: Location, timing and intensity.
Rubs
Pericardial Friction Rub: not constant, more in expiration.