We all know how to check our pulse by feeling it on our wrist or on either side of our neck. But did you know that there is a special pulse that gives even more accurate information about the functioning of the heart, which is heard by placing a tube directly on the chest? That is what we call the 'Apical Pulse'. This is a very important thing, so let's talk about it in detail today.
What is this Apical Pulse?
Simply put, the Apical Pulse is where you can get the most accurate idea of your heart rate . It is also called the 'Point of Maximal Impulse' (PMI) and the 'Apex Beat'.
We usually check our pulse at the wrist (called the 'radial pulse') or on either side of our neck (called the 'carotid pulse'), right? These are the pulses that run along the blood vessels of our body, that is, along the 'arteries'. We can easily feel these pulses by placing two or three fingers on them. Then we can feel the pressure waves that occur every time the heart beats.
But this Apical Pulse is different. This is not a pulse in an artery. You don't feel a pressure wave here. What you feel, or what the doctor hears, is the contraction of the lower chamber on the left side of your heart, the 'Left Ventricle'. Imagine, every time your heart beats, it is this Left Ventricle that pumps blood to the entire body through the main blood vessel called the 'Aorta'.
Isn't it amazing that we can feel our own heart beating? But sometimes it can be a little difficult to find this apical pulse with just your fingers. If you've ever been to a hospital, you've probably seen the medical staff checking this apical pulse.
Where is the Apical Pulse located?
This Apical Pulse is located just above the apex of your heart. Do you know what the apex of the heart is? It is the tip-like part of your heart that points downward on the left side, specifically the lowest tip of the Left Ventricle. However, in rare cases, some people's hearts may be turned to the right, which we call 'dextrocardia'. In such a person, the apex of the heart is on the right side.
So, where exactly is the apex of the heart in adults?
In an adult, it is located on the left side of the chest, between the fifth and sixth ribs, counting from the top of the rib cage down. Doctors call this the 'fifth intercostal space', which is the space between the ribs.
Where are the little children?
For children under the age of 7, this location is a little different. Their heart apex is located between the fourth and fifth ribs. That is, in their 'fourth intercostal space'.
Why is the apical pulse measured?
Your doctor can learn a lot of valuable information by measuring this apical pulse. There are now automatic devices that quickly measure and display the pulse rate. Although they show the heart rate, they do not accurately indicate the rhythm of the heart or the strength of the pulse. However, the apical pulse can provide all of this information relatively quickly, using only a stethoscope .
A doctor may measure your apical pulse for these reasons:
- Check your general health and well-being .
- Check your heart health .
- Check how you are doing after a test, treatment, or surgery .
- Collect baseline information that can be compared with future pulse checks.
How is the Apical Pulse measured?
The doctor uses a stethoscope to measure the apical pulse. It is placed directly on your skin to listen. Therefore, this is done while you are covered with a cloth or blanket to protect your privacy, if necessary.
The doctor usually follows these steps:
- You will be asked to lie on your back , or to turn slightly to the left. This is done to better feel your heart beat.
- They use their fingers to find the location of the apical pulse.
- The end of the tube (either the 'bell' or the 'diaphragm') is placed on your chest.
- They will listen carefully for about 60 seconds. Don't worry if they don't say anything at this point, or if it seems like it's taking a while. This is normal. The doctor needs to listen very carefully to identify the heartbeat.
- Then the doctor will remove the tube from your chest.
Sometimes your doctor may also check your pulse in other places. For example, they may want to measure your 'apical-radial pulse'.
What is the apical-radial pulse?
The doctor may want to measure both your apical pulse and your radial pulse, which is measured at the wrist. This shows how well blood is moving from your heart to the rest of your body. The doctor may also need to have another person help with this. While one person measures the apical pulse, the other person will check the radial pulse within 60 seconds.
Ideally, your apical pulse and radial pulse should be the same. However, if you have a weak heart or if you have vascular disease , your radial pulse may be lower than your apical pulse. The difference between these two values is called a pulse deficit . This pulse deficit helps your doctor diagnose and monitor various conditions that affect your heart and blood vessels.
What is the normal range of the apical pulse?
The normal apical pulse range for most adults is between 60 and 100 beats per minute (bpm) . This is the ideal range to be in when you are at rest. However, things like these can cause your pulse to drop too low:
- If you exercise .
- If you drink things that contain caffeine (like tea, coffee).
- When you are stressed or anxious .
As you age, your heart rate may naturally slow down a bit. Also, certain medications and medical conditions can affect your heart rate. It's best to talk to your doctor to find out exactly what a healthy heart rate range is for you.
It is normal for young children to have a higher heart rate than adults. This normal range varies depending on their age. Babies under three months old have the highest rate (123-164 beats per minute). This rate gradually decreases as they get older. Talk to your child's doctor to learn more about the appropriate heart rate ranges for your child at different ages.
What can be learned from the Apical Pulse?
The apical pulse can reveal the symptoms of a variety of medical conditions . This is because it allows the doctor to hear more than just your heart rate. These include:
- How is the energy in each heartbeat ?
- How long does each heartbeat last ?
- How is the overall rhythm of the heart ?
This apical pulse can help your doctor diagnose conditions such as:
- Heart rhythm disorders (arrhythmias) , for example, atrial fibrillation.
- Heart valve disease , for example, blood leaking from the valves (regurgitation) or narrowing of the valves (stenosis).
- Thickening of the heart muscle (Hypertrophic Cardiomyopathy) .
- Enlargement of the heart chambers ('Diluted Cardiomyopathy') .
Can the Apical Pulse sometimes be difficult to find?
Yes, sometimes the doctor may not be able to find your apical pulse. This may be the case if you have any of the following conditions:
- Obesity (also called 'obesity', which means extreme obesity).
- Chronic lung disease (Chronic Lung Disease) .
- Fluid accumulation around the heart (pericardial effusion) .
- Fluid accumulation around the left lung ('Left Pleural Effusion') .
If that happens, the doctor will check your pulse in other places, and if necessary, perform other heart tests. It's nothing to worry about.
Finally, things to remember
Even though we have so many devices these days, checking your pulse is still a very important part of medicine. Your apical pulse is an important vital sign that helps your doctor detect problems with your heart. Your doctor may check your apical pulse during a routine checkup. If you are in the hospital, your medical team will often check your apical pulse.
So, talk to your doctor about your apical pulse and what it says about your heart health. Don't worry, it's just a routine test, but it's very important! It can tell your doctor a lot about your heart.
` Apical pulse, heart rate, auscultation, heart health, pulse, heart rhythm, heart disease
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