Cardiac apical impulse is normally localized at the fifth intercostal space, midclavicular line. Abnormalities include:
- Forceful apical thrust: Left ventricular hypertrophy
- Lateral and downward displacement of apex impulse: Left ventricular dilatation
- Prominent presystolic impulse: Hypertension, aortic stenosis, hypertrophic cardiomyopathy
- Double systolic apical impulse: Hypertrophic cardiomyopathy
- Sustained lift at lower left sternal border: Right ventricular hypertrophy
- Dyskinetic (outward bulge) impulse: Ventricular aneurysm, large dyskinetic area post MI, cardiomyopathy