What have we learned by determining the location and size of our patient’s precordial movement? Well, to begin with, we learned that the location was normal, it’s mid-clavicular line, fifth intercostal space. But the size of the impulse? That was not normal. The normal size impulse is about that of a dime. This is more like a quarter size impulse. That tells us something. It tells us that it is very likely that this is an hypertrophied ventricle, that the left ventricle at the apex is pushing up in a larger than normal area because of hypertrophy.
Location/size graphic
The normal location of the apical impulse is the fifth intercostal space at the mid-clavicular line. It may be enlarged in patients with left ventricular hypertrophy.