Impalpable apex beat
If the apex beat is impalpable then the following possibilities should be considered:
- the patient has an excessively muscular or fat chest wall
- left pleural effusion, pneumothorax, or emphysema
- there may be a large pericardial effusion
- constrictive pericarditis
- marked mediastinal shift
- dextrocardia
- very rarely, massive left ventricular hypertrophy may cause the apex beat to be displaced past the mid-axillary line
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