I remember a patient, let’s call her Sarah, coming into my clinic once. Her brow was furrowed with worry. She’d been feeling some odd flutters in her chest – nothing too dramatic, she said, but enough to make her anxious. After we chatted for a bit, I reached for my stethoscope. That cool metal disc against the skin, it’s a familiar moment for many, right? As I gently placed it on her chest, just in the right spot, we both listened. Lub-dub. Lub-dub. That specific sound, that particular spot I was listening to – that was her apical pulse. It’s a little window directly to the heart‘s rhythm.
What Exactly is Your Apical Pulse?
So, what is this apical pulse we’re talking about? Think of it as the pulse point right on your chest that gives us the most accurate snapshot of your heart rate. You might also hear it called the point of maximal impulse (PMI) or the apex beat. It’s essentially where your heart’s beat is felt most strongly.
Now, you might be thinking, “I can feel my pulse on my wrist, what’s different?” And you’re absolutely right! Those pulses, like the one on your wrist (we call that the radial pulse) or along your neck (the carotid pulse), are super useful. When you press your fingers there, you’re feeling the pressure waves your heart creates each time it contracts and sends blood through your arteries.
Your apical pulse is a bit different, though. It’s not an arterial pulse in the same way. Instead of feeling pressure waves, we’re feeling (and listening to) your left ventricle – that’s the powerful lower left chamber of your heart – as it contracts. Each time it squeezes, it pushes blood out of your heart through the aorta (your body’s main highway for blood) and out to the rest of you. It’s pretty amazing to think you can actually feel your heart moving like that. Sometimes it’s a bit subtle to find with just fingers, which is why we often use a stethoscope.
Where do we find it?
Your apical pulse is located right over the apex of your heart. The apex is just the pointy tip of your left ventricle, which usually points downward and to the left side of your chest.
- For most adults, we find this spot between the fifth and sixth ribs, counting down from the top.
- In little ones, kids under 7, their heart sits a bit differently. Their apex is usually in what we call the fourth intercostal space (that’s the little gap between their fourth and fifth ribs).
- And, just a quick note, some folks have a condition called dextrocardia, where their heart is flipped, pointing to the right side. So, their apical pulse would be on the right.
Why Do We Listen to Your Apical Pulse?
Checking your apical pulse gives us some really valuable clues about what’s going on with your heart. Sure, those automatic blood pressure cuffs are handy for a quick heart rate, but they don’t tell the whole story. Listening to the apical pulse lets us hear not just how fast your heart is beating, but also its rhythm and the strength of each beat. All that with just a stethoscope!
We might measure your apical pulse to:
- Get a good sense of your general health and wellbeing.
- Specifically check on your heart’s health.
- See how you’re doing after a medical test, a procedure, or even surgery.
- Gather some baseline information so we can compare it with future checks. It’s like getting a starting point.
How We Check Your Apical Pulse
When I or another doctor or nurse checks your apical pulse, we use a stethoscope. And to get the clearest sound, the stethoscope needs to be placed directly on your bare skin. Don’t worry, we’ll always make sure you’re comfortable and offer a sheet or blanket for privacy.
Here’s generally what happens:
- I’ll ask you to lie down, either flat on your back or maybe turned just a little onto your left side. This position can sometimes bring the heart a bit closer to the chest wall.
- I’ll use my fingers to gently feel for the spot where your apical pulse is strongest.
- Then, I’ll place the end of the stethoscope (either the flat part, the diaphragm, or the bell-shaped part) onto that spot on your chest.
- And then I listen. I’ll usually listen for a full 60 seconds. It might feel like a long time, and I might be quiet, but that’s totally normal. I’m just concentrating, listening carefully to each beat.
- Once I’m done, I’ll gently remove the stethoscope.
Sometimes, we check two pulses at once: The Apical-Radial Pulse
Occasionally, we might want to compare your apical pulse with your radial pulse (the one at your wrist) at the exact same time. This is called an apical-radial pulse check. It helps us see how well blood is actually traveling from your heart all the way out to your limbs. To do this, sometimes another colleague will help. One of us listens to your apical pulse while the other feels your radial pulse, both for the same 60 seconds.
Ideally, the number of beats we count at your apex and your wrist should be the same. But if your heart is a bit weak, or if there’s some vascular disease (problems with your blood vessels), the radial pulse might be lower than the apical one. That difference is called a “pulse deficit.” Finding a pulse deficit can give us important clues for diagnosing and keeping an eye on various conditions affecting your heart and blood vessels.
Normal Apical Pulse: What to Expect
For most adults when they’re resting, a normal apical pulse range is between 60 and 100 beats per minute (bpm). Of course, your pulse will naturally go up if you:
- Get some exercise.
- Have a cup of coffee or an energy drink (hello, caffeine!).
- Are feeling stressed out or a bit anxious.
As we get older, our resting pulse might naturally be a little lower. Certain medications and some medical conditions can also affect your pulse. It’s always a good idea to chat with your doctor about what a healthy pulse range is specifically for you.
It’s perfectly normal for children to have a higher pulse rate than adults. Their normal range changes as they grow. It’s highest when they’re tiny babies (under three months old, it can be around 123 to 164 bpm!) and then it gradually slows down as they head towards adulthood. We always keep an eye on this and can tell you what’s typical for your child’s age.
What Your Apical Pulse Can Tell Us
Listening to your apical pulse is more than just counting beats. It lets us hear:
- The strength of each heartbeat – is it strong and steady, or perhaps a bit weak?
- How long each heartbeat lasts.
- The overall rhythm of your heart – is it regular like a drum, or are there extra beats, missed beats, or a completely irregular pattern?
Because of this, checking the apical pulse can help us pick up early signs of several conditions. For example, it might help point towards:
- Arrhythmias: These are irregular heartbeats, like atrial fibrillation (a common one where the heart beats irregularly and often fast).
- Heart valve disease: This could be issues like leaky valves (regurgitation) where blood flows backward, or narrowed valves (stenosis) that make it harder for blood to flow through.
- Hypertrophic cardiomyopathy: This is when the heart muscle becomes unusually thick.
- Dilated cardiomyopathy: This is when the heart’s main pumping chamber, the left ventricle, becomes enlarged and weakened.
Sometimes, it can be a bit tricky to hear the apical pulse clearly. This might happen if someone has:
- Obesity
- Chronic lung disease (like emphysema)
- Pericardial effusion (fluid around the heart)
- Left pleural effusion (fluid around the left lung)
If we can’t detect it easily, don’t you worry. We have other ways to check your pulse and other tests we can do to make sure your heart is doing okay.
Key Things to Remember About Your Apical Pulse
Here are a few key takeaways about your apical pulse:
- Your apical pulse is the heartbeat we feel or hear directly over the tip of your heart, on your chest.
- It gives us the most accurate count of your heart rate and also tells us about your heart’s rhythm and the strength of its beats.
- We listen to it with a stethoscope, usually in the space between your fifth and sixth ribs on the left side.
- For most adults at rest, a normal range is 60 to 100 beats per minute, but this can vary from person to person and with activity.
- Checking your apical pulse is a simple but very useful way for us to assess your overall heart health and can sometimes be the first clue to conditions like arrhythmias or valve problems.
Your heart is an incredible organ, working tirelessly for you every second of the day. Listening to its rhythm through the apical pulse is just one of the ways we can partner with you to keep an eye on how you’re doing. We’re always here to listen, in every sense of the word. You’re doin’ great just by learning more about your health!