Apical Pulse

Pulsation at the top section of the heart is referred to as the apical pulse. Occasionally, it is called PMI or the ‘point of maximum pulse.’ In a health individual, the heart is located in such a way so that the apex or the top part occurs on the left side of the chest and points downwards towards the left. A person has to locate the apical pulse to measure it and then interpret the findings after measurement.

Measuring apical pulse

Listed below are the steps by which the apical pulse can be taken

• Feel for and locate the clavicle or the collarbone situated at the top part of ribcage. Just below is the first rib. Now, feel and locate the first intercostal space, i.e., space between two ribs.
• Move downwards while counting the ribs and come to the 5^th intercostal space situated between the 6^th and 5^th ribs. The midclavicular line is an imaginary line which runs on the left side from the midsection of the collarbone to the nipple. One can now feel and hear the apical pulse at the junction of the midclavicular line and the 5^th intercostal space.
• You can use a stethoscope or regular touch to feel the apical pulse. However, it can be quite difficult to feel it via touch, particularly in women where the apical pulse may be located just under the breast tissue.
  • Check the stethoscope to verify whether it is working. Warm up the diaphragm of the instrument by rubbing it a bit. Now place it on the area of the apical pulse to hear it. The person has to breathe normally via nose to reduce breathing sounds and facilitate easier hearing of the apical pulse.
  • The apical pulse usually goes ‘lub-dub’ which is regarded as one heartbeat. Count the number of ‘lub-dubs’ per minute using a watch. The total number of lub-dubs per minute is the heart rate or pulse rate. In adults, the normal pulse rate is about 60 to 100 beats in a minute. Children have different normal apical pulse rates; it is 80 to 140 in newborns, 75 to 120 in 4 to 9 year olds, and 50 to 90 in 10 to 15 year olds.

Interpreting the findings of apical pulse measurement

Interpreting an apical pulse or heartbeats can be difficult and requires technical expertise. Listed below are some things that can be learned while taking an apical pulse, which can then be used to interpret the findings.

• Faster than normal pulse can be due to exercising, or can be a sign of illnesses like hypertension, infection, or cardiac disease.
• If the pulse rate or the heart is slow then it may be regarded as normal adaptation by the heart for a person who is healthy. A few medications, like beta-blockers for hypertension, can also lower heartbeats, especially in the elderly.
• Displaced apical pulse, i.e., shifting of the apical pulse to the right or left from its original location, may occur due to varied causes.
  • Lung diseases, particularly in heavy smokers, can cause the apical pulse to displace to the right. This is because the diaphragm gets pulled downwards for facilitating greater flow of air into the lungs in such patients, which in turn causes the heart to get displaced to the right and downwards.
  • Pregnant women and obese people tend to have an apical pulse that has moved to the left because the additional abdominal contents tend to displace the heart.
  • Irregular pulse is a common feature in older individuals. Irregular pulse may occur due to fatigue or damage of the cells that regulate the cardiac rhythm.

The shape of pulses can also be used to interpret and analyze findings. A weak pulse may be indicative of low volume of blood in vessels which poses difficulties in feeling the pulse. Bounding or sharper apical pulse may signify stiff arteries due to lack of space in the vessels for the increased blood being pumped out by the heart.

It may be noted that normal apical pulse in adults is 60 to 100 beats a minute. It can be slower or faster in people with diseases. However, highly trained athletes may feature a very low apical pulse rate which is normal, while people doing workouts may have pulse rates that are above 100.

Apical Pulse – Locations

There are several places on the human body where a pulse can be felt. These are as follows:

• The radial pulse located on the wrist on the palmar hand surface below the thumb.
• The carotid pulse that can be felt on both sides of the trachea in the neck.
• The femoral pulse located in the groin between the trunk and leg fold.
• The brachial pulse can be felt within the elbow.
• The popliteal pulse is present behind the knee.
• The pedal pulse can be felt in the top center part of the foot. It is not easy to find.
• The posterior tibial pulse can be felt on the inner section of the leg at the ankle, just behind the bump.