Medicine PG poster presentation

1. APICAL IMPULSE
Definition: It is the outermost and lowermost point of maximum impulse (PMI) in early
systole, which imparts a perpendicular gentle thrust to a palpating finger, followed by a slight
medial retraction in the late systole.
Cause of Normal Apical Impulse: Anterior and counter clock-wise rotation of LV due to
isovolumic contraction during early systole and medical retraction due to clock-wise rotation of
the LV during late systole.
Characteristics of Normal Apical Impulse: Location – Left 5th
ICS at or medial to mid-
clavicular line and <10cm from mid-sternal line. Extent - <3cm in diameter which is one ICS.
Duration - <50% of systole.
Abnormal Apical Impulse:
 ABSENT : Dilated cardiomyopathy, Pericardial effusion, Behind the rib, Dextrocardia,
Obesity, COPD, Left pleural effusion
 TAPPING : Mitral stenosis (palpable S1 - closing snap)
 HYPERDYNAMIC : Increased in amplitude, duration is >1/3 to <2/3 of systole, occupies
more than one intercostal space. Occurs in LV volume overload (AR, MR,VSD, PDA,
High output states)
 HEAVING : Increase in amplitude, duration is >2/3 of systole and occupies more than
one intercostal space. Occurs in LV pressure overload (AS, HTN, Coarctation of aorta)
 DIFFUSE : Occupying more than 1 ICS. Occurs in LV aneurysm, Eccentric LVH as in
AR
 DOUBLE : HOCM, AS with AR, Left dyssynergy, LV aneurysm
 TRIPLE OR QUADRUPLE : HOCM
 RETRACTILE : Severe TR
References: Clinical Examination in Cardiology - B.N.Vijay Raghawa Rao,
Bedside Cardiology - Jules Constant, Manual of Practical Medicine - R.Alagappan;
Prepared by Dr.Anvesh Karthik Yalavarthy

2. References: Clinical Examination in Cardiology - B.N.Vijay Raghawa Rao,
Bedside Cardiology - Jules Constant, Manual of Practical Medicine - R.Alagappan;
Prepared by Dr.Anvesh Karthik Yalavarthy