APICAL PULSE! please help!

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Hey, im a first year nursing student and i have no idea if im in the right area, but i was wondering if you could help me with the APICAL PULSE! i have a question which says

(1)which normal variations may affect the location of the apical impulse?

(2) which ABNORMAL conditions may affect the location of the apical impulse?

i am a bit stuck! and i also have a question

(3) STATE 4 guidelines to distinguish S1 from S2 sounds! it would be greatly appreciated if someone helped out!

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I am doing this test now and I am also stuck.....did you find any of the answers? please share!

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Off the top of my head, age will have something to do with the location- newborn babes have the apical impulse at about the 4th ICS rather than the 5th in older children and adults. An abnormal situation like cardiac enlargement will displace the impulse down and left, and the impulse will be palpable at more than one interspace. Also some people have their heart on the right side rather than the left. Rare, but it happens.

Guidelines for S1 & S2:

-two sounds close together, S1 is the first

-S1 louder at apex, S2 louder at base

-S1 coincides with carotid artery pulse (palpate as you auscultate)

-S1 coincides with R wave (upstroke of QRS complex) if they are on an ECG.

HTH!

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Thanks! that helped! :)

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