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).

See the Heart page.