The apical pulse is the pulse that is felt at the apex of the heart. The heart of a healthy person is located in such a way that the apex is on the left side of the chest, pointing downwards and to the left. This pulse rate is also sometimes referred to as the “point of maximum impulse”, or PMI. To measure the apical pulse, you must know how to find it, and how to interpret your measurement afterwards.
Step
Method 1 of 3: Measuring Apical Pulse
Step 1. Begin by asking the patient to undress
To measure the apical pulse, you must be able to directly access the patient's chest area.
Step 2. Feel the first rib by looking for the collarbone
Feel the collarbone. The collarbone is also known as the shoulder blade. This bone can be felt above the ribs. Just below the collarbone, you should be able to find the first rib. The distance between the two ribs is called the intercostal space.
Feel for the first intercostal space - this is the distance between the first and second ribs
Step 3. Count the ribs down
From the first intercostal space, move your finger down to the fifth intercostal space counting the ribs. The fifth intercostal space should be between the fifth and sixth ribs.
If you are measuring the apical pulse in a female patient, you can use 3 fingers to feel it just below the left breast. Usually this method can also be used in male patients. That way, you can measure the apical pulse without having to count the ribs
Step 4. Draw an imaginary line from the center of the left collarbone through the nipple
This line is called the mid-clavicular line. The apical pulse can be felt and heard at the junction of the fifth intercostal space and the mid-clavicular line.
Step 5. Decide whether you will touch it directly or using a stethoscope
The apical pulse can be measured by touching it or using a stethoscope. It may be very difficult to feel the apical pulse, especially in women, because breast tissue can mask this pulse. It may be easier to measure the apical pulse with a stethoscope.
The apical pulse is difficult to feel with just the fingers in most patients. This pulse is generally too weak to detect without a stethoscope unless the patient is angry or in shock
Step 6. Prepare your stethoscope
Remove the stethoscope from the neck, and point the other side toward the person you are examining. Put the stethoscope to your ear and hold the diaphragm (the part you place to hear someone's pulse).
Gently rub the diaphragm of the stethoscope to warm it up, then tap gently to make sure you can hear the sound through it. If you can't feel anything through the diaphragm of the stethoscope, check that the stethoscope is firmly attached to the diaphragm because if it loosens, you may not hear anything
Step 7. Place the stethoscope at the point where you can feel the apical pulse
Ask the person you are examining to breathe normally through their nose as this will reduce breath sounds so you can hear the heartbeat more easily. You should be able to hear two sounds: lub-dub. This sound is considered as a single beat.
- Ask the patient to turn their back on you. That way, it will be easier for you to hear his pulse.
- The pulse usually sounds like the gallop of a horse.
Step 8. Count how many lub-dubs you hear in one minute
This is the heart rate. Think of a way to describe the sound you hear. Is it hard? Strong? Is the rhythm regular, or does it sound random?
Step 9. Determine the person's heart rate
Be prepared with the watch on the other side so you can count the pulse. Count how many "lub-dubs" you hear in one minute (60 seconds). The normal heart rate for adults ranges from 60 - 100 beats per minute. These pulses are different in children.
- In newborns up to three years of age, the normal pulse rate is 80 - 140 per minute.
- For children younger than nine years, the normal pulse rate is 75-120 per minute.
- For children between the ages of 10 and 15, a pulse rate of 50 - 90 per minute is normal.
Method 2 of 3: Interpreting Your Findings
Step 1. Understand that interpreting heart rate is difficult
Defining the pulse, especially the apical pulse is an art. However, there is much to be learned from the apical pulse. This is explained in the next step.
Step 2. Determine if the heart rate you hear is slow
If the pulse is very slow, this may be a normal form of adaptation in a healthy person. Some medicines can also make the heart beat more slowly, especially in elderly patients.
- One example is beta blocker drugs (such as metoprolol). This drug is commonly used to treat high blood pressure and can slow the heart rate.
- A slow heart rate can be weak or strong. A strong heart rate is a sign your patient is healthy.
Step 3. Consider whether the heart rate you hear is very fast
If the pulse is heard very fast, this can be normal in people who exercise. Children also have a faster pulse rate than adults. However, a pulse like this can also be a sign:
High blood pressure, heart disease, or infection
Step 4. Consider possible pulse shifts
The location of the pulse may be different (maybe more left or right where it should be). People who are obese or pregnant women may experience a shift in the apical pulse to the left because the heart has shifted due to the content in the abdomen.
- The apical pulse in heavy smokers with lung disease may shift to the right. This is because in lung disease, the diaphragm will be pulled down to get as much air into the lungs as possible, and in this process the heart will be pulled down and to the right.
- If you suspect your patient's heart rate is shifting, also slide the stethoscope to the side and check again.
Step 5. Watch for an irregular pulse
The pulse may also be irregular. This generally occurs in the elderly. The heart has a certain rhythm, and over time, the cells that control the heart's rhythm become exhausted or damaged. As a result, the pulse becomes irregular.
Method 3 of 3: Learn More About Heart Rate
Step 1. Understand the pulse
The pulse is the heartbeat that can be felt or heard. Pulse rate is often measured as heart rate, which is a measure of the speed at which a person's heart beats; expressed in beats per minute. A person's normal pulse rate is between 60 to 100 beats per minute. A pulse that is slower or faster than this may signal a problem or illness. But it may also be normal for some people.
For example, an athlete who trains a lot has a very slow pulse, while someone who exercises may have a heart rate of more than 100 per minute. In both cases, the heart rate is sequentially lower or higher than it should be in most situations, but that doesn't necessarily mean there's a problem
Step 2. Understand that the pulse can also be analyzed based on the sound
In addition to using the rate, the pulse can also be analyzed based on the sound: is it soft, or does it sound weak? If the pulse is loud, does it mean it is sharper than usual? A weak pulse can indicate that a person has a low volume of blood in their veins, making it difficult to feel the pulse.
For example, a loud pulse may be found in a patient who is scared or has just run
Step 3. Know where the pulse can be felt
There are many places where a pulse can be felt on the body. Some of them are::
- Carotid pulse: located on either side of the trachea, which is the stiff part of the neck. The carotid arteries are paired, and carry blood to the head and neck.
- Brachial pulse: located on the inner side of the elbow.
- Radial pulse: felt on the wrist at the base of the thumb, on the surface of the palm.
- Femoral pulse: felt in the groin, in the crease between the legs and the upper body.
- Popliteal pulse: behind the knee.
- Posterior tibial pulse: located at the ankle, on the inside of the foot, just behind the medial malleolus (the bulge at the base of the lower leg).
- The dorsalis pedis pulse: over the sole of the foot, in the middle. This pulse is often difficult to feel.
