Introduction

Apical pulse, also known as point of maximal impulse (PMI), is the location on the chest where the heart’s sounds are loudest and clearest. Monitoring the apical pulse is essential for assessing a patient’s cardiovascular function and detecting abnormalities. In this article, we will discuss three ways to take an apical pulse: using a stethoscope, palpation, and auscultation.

1. Using a Stethoscope

A stethoscope is the most common tool used to measure an apical pulse. To take the apical pulse using a stethoscope, follow these steps:

a. Position the patient in a comfortable sitting or lying position, with their upper body exposed.

b. Locate the point of maximal impulse (PMI) on the left side of the chest, about two finger-widths below the intercostal space and one finger-width medial to the mid-clavicular line.

c. Place the diaphragm of the stethoscope on the PMI and gently press against the chest.

d. Ask the patient to relax and breathe normally.

e. Listen carefully for any irregularities in rhythm or intensity of heartbeats.

f. Count each lub-dub sound (S1 and S2 heart sounds) for one full minute.

2. Palpation

Palpation is another technique that can be used to find an apical pulse by feeling for it on a patient’s chest.

a. Position the patient in similar manner as with stethoscope method.

b. Use your index and middle fingers to lightly trace along the left side of your patient’s sternum until you reach the fifth intercostal space.

c. Move slightly leftwards towards mid-clavicular line while still maintaining your fingers in that intercostal space.

d. Once you locate PMI, note its intensity, size and quality.

Although palpation may be less accurate than using a stethoscope, it can still be a valuable method if no other tool is available or in noisy environments.

3. Auscultation

Auscultation involves listening to the heart sounds with your ear directly against the patient’s chest.

a. Position the patient similarly as with previous methods.

b. Locate the PMI as described earlier.

c. Press your ear against the patient’s chest while maintaining the anatomical position.

d. Listen for heartbeats in similar manner to stethoscope method, for one full minute.

This method may not be as accurate or hygienic as using a stethoscope, but it can be helpful in situations where a stethoscope is not available.

Conclusion

Taking an apical pulse is a vital skill for healthcare providers as it helps to evaluate cardiovascular health and identify potential issues. By mastering these three techniques—using a stethoscope, palpation, and auscultation—you’ll be equipped to assess apical pulses effectively in a variety of settings.