point of maximum impulse (PMI); apical impulse

Introduction

Normally discrete area of localized contraction at the 5th intercostal space, mid-clavicular line.

Abnormalities:

• apex displaced, impulse poor & diffuse:
  • cardiomyopathy
• trifid:
  • hypertrophic cardiomyopathy
• tapping quality, localized
  • mitral stenosis
• sustained, but not displaced:
  • aortic stenosis
  • left ventricular hypertrophy
• hyperdynamic:
  • mitral regurgitation