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Heart Rate and Pulse

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Inspection and Palpation

 

In many individuals, the heart-beat may be observed or palpated at about the 5th intercostal space, 7-9 cm left of the midsternum. This is the apical impulse (location of the apex of the heart). With the palm of the hand, one may feel the apical impulse, which is usually the point of maximum impulse, or PMI. The strength of the PMI is increased and the location varies in various conditions, such as exercise, emotions, left and right ventricular hypertrophy and hyperthyroidism. Sometimes a vibration (or thrill) is palpated on the chest wall.

 

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