Different types of apex beat
- thrusting displaced apex beat is caused by volume overload: an active large stroke volume ventricle eg aortic or mitral regurgitation or left to right shunts.
- sustained apex beat is caused by pressure overload eg aortic stenosis, gross hypertension.
- tapping apex beat - mitral stenosis.
- diffuse pulsation asynchronous with apex beat - left ventricular aneurysm.
- double or triple impulse may occur in hypertrophic obstructive myopathy.
- an impalpable apex beat - obesity, overinflated chest, pericardial effusion. Also consider dextrocardia.
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