Causes Of Non Palpable Apical Impulse Of Heart

(This is a Written Question Of Final Professional MBBS ( Medicine) Examination of Bangladesh)

• Obese person
• Thick muscular chest wall
• Soft tissue (breast)
• Emphysema
• Pericardial effusion
• Dextrocardia

Other Things you Need to Know.
Precardium: Palpation

* Palpate the precordium with the palmar surface of your hand over the aortic, pulmonary, parasternal and apical areas of the heart.

* Determine the lower and outermost precardiac impulse, the apical impulse.

* Press your finger over the apical impulse identify its location, amplitude, duration and assess the rapidity of the upstroke and downstroke.

Normal: In thin individuals, the apical impulse is recognizable. Apical impulse is normally in 5th interspace just medial to midclavicular line and is about 1-2 cm in diameter. The apical impulse feels like a gentle tap and is small in amplitude and corresponds to first two thirds of systole.