Palpating the apical impulse

The apical impulse is associated with the first heart sound and carotid pulsation. To ensure that you’re
feeling the apical impulse and not a muscle spasm or some other pulsation, use one hand to palpate the
patient’s carotid artery and the other to palpate the apical impulse. Then compare the timing and
regularity of the impulses. The apical impulse should roughly coincide with the carotid pulsation. Note
the amplitude, size, intensity, location, and duration of the apical impulse. You should feel a gentle
pulsation in an area about ½ in to ¾ in (1.5 to 2 cm) in diameter.

Elusive impulse The apical impulse may be difficult to palpate in patients who are obese or pregnant and
in patients with thick chest walls. If it’s difficult to palpate with the patient lying on his back, have him lie
on his left side or sit upright.