I dunno how to palpate an apical pulse. Help?

  1. Hi all.

    I know that the Apical Pulse or PMI or mitral valve or whatever you want to call it is located at the left 5th intercostal space, midclavicular line. Right?

    Well I can never seem to feel it. Because on women, it's where their boobs are! And on men, they've got a huge pile of muscle there. And I know if you can you're supposed to try to lift the breast out of the way right? But unless I'm mistaken, it's smack dab under it a lot of the time. I'm as skinny and flat-chested as they come, and I have trouble finding it on myself.

    Any tips? =/

    Thanks,
    drenched

    P.S. Ahhh....my boards are in 9 hours! *scurries off to cramming*
    •  
  2. 12 Comments

  3. by   cardiacRN2006
    Hmm. The way to count an Apical pulse is with your stethoscope.
  4. by   onyx77
    Quote from drenched
    Hi all.

    I know that the Apical Pulse or PMI or mitral valve or whatever you want to call it is located at the left 5th intercostal space, midclavicular line. Right?

    Well I can never seem to feel it. Because on women, it's where their boobs are! And on men, they've got a huge pile of muscle there. And I know if you can you're supposed to try to lift the breast out of the way right? But unless I'm mistaken, it's smack dab under it a lot of the time. I'm as skinny and flat-chested as they come, and I have trouble finding it on myself.

    Any tips? =/

    Thanks,
    drenched

    P.S. Ahhh....my boards are in 9 hours! *scurries off to cramming*
    I was never taught to palpate the apical pulse.
    Do you mean auscultate? You don't have to be in that exact spot to listen to the apical pulse. You may find that different spots or positions on different pts work better. But, Yes, that is the general area.
  5. by   smk1
    The PMI can be felt exactly where you describe it, but it isn't always palpable on all people. Kids are far easier patients to find it on. you can try having the patient lean forward to bring the anatomy closer to the chest wall. Some people you just won't be able to feel it though.
  6. by   drenched
    Oh whew. Thanks you guys! I'm always able to hear it, but I thought we had to be able to palpate it too. Good to know I'm not entirely insane in not being able to feel it! =P
  7. by   ramonmalino
    In school we were taught that we had to palpate, not only auscultate, the apical pulse. In clinical thats how our instructors wanted the HR taken... I guess its more accurate(?)
  8. by   BBFRN
    Yes, as mentioned by SMK1, you can palpate the PMI in some people- usually children and smaller adults. This was something that was taught in my BSN health assessment course, but not in any of my ASN or LPN courses.
  9. by   student456
    ok i have a problem with this too!

    we were taught to palpate it and i never understand how to feel it or get it ihave the same problems as the OP...so you can do it with your stethoscope? isnt that the same thing as listening to your heart beat though? so for example if you have to give an antihypertensive drug can you just listen to the heart beat and count the beats then give it? why wouldnt you be able to just palpate the carotid or radial pulse before giving it....wouldnt it be the same thing?

    sorry if my questions are stupid i just dont understand apical pulses yet
  10. by   tnbutterfly
    Quote from muhaha
    ok i have a problem with this too!

    we were taught to palpate it and i never understand how to feel it or get it ihave the same problems as the OP...so you can do it with your stethoscope? isnt that the same thing as listening to your heart beat though? so for example if you have to give an antihypertensive drug can you just listen to the heart beat and count the beats then give it? why wouldnt you be able to just palpate the carotid or radial pulse before giving it....wouldnt it be the same thing?

    sorry if my questions are stupid i just dont understand apical pulses yet
    You would want to take the BP before giving antihypertensive meds.

    If the patient is on antiarrhythmic meds., an apical pulse would be more accurate....especially if they are not in a sinus rhythm because all of the irregular heart beats may not be palpable radially. It would be important to auscultate the apical pulse to detect irregular beats.
  11. by   emtb2rn
    :yeahthat: and apical-radial=pulse deficit
    Last edit by emtb2rn on Aug 7, '07 : Reason: typed too quick.
  12. by   BBFRN
    You don't palpate it instead of auscultating. You can palpate in addition to auscultating for a more thorough assessment. You want to note the PMI's (Point of Maximal Impulse) position and diameter. If it is >2cm and lateral to the midclavicular line, it could mean the patient has LV enlargement. Of course, this would also show up on a CXR.

    http://courses.washington.edu/medicm...nchmarkA04.pdf

    The above link explains a thorough cardiac assessment very well- including palpating the PMI.

    If you can palpate the PMI, you want it to correlate with the carotid pulse.
  13. by   zahryia
    Is PMI an interchangeable term as the apical pulse. Or is there a difference?
  14. by   BBFRN
    They are located in the same place, but officially the apical pulse is auscultated, and the PMI is palpated/inspected.

close