Apical Pulse: How Doctors Measure It and What It Can Tell You
Read on to learn more about the apical pulse, how doctors measure it, and what it can tell you.
Unlike other locations where you can feel your pulse, your apical pulse is very near your heart. This means that monitoring your pulse from this point is like listening directly to your heart, which has a few benefits for you and your doctors.
First, it is noninvasive, making it a more comfortable option than other tests. Additionally, your apical pulse tends to be very reliable when assessing cardiac function compared to the different pulse points.
Your apical pulse is one of nine common pulse sites. The apical pulse point below your left nipple corresponds to the bottom, pointed portion of your heart.
There are pulse sites located all over the body. Other than the apical pulse, there are eight other common pulse points:
- Temporal pulse: You can find these points at your temples.
- Carotid pulse: This pulse occurs just below the jaw on the side of the neck.
- Dorsalis pedis: This is the pulse on the top of your foot.
- Brachial pulse: You can find this pulse on your inner elbow, or the crook of your arm.
- Radial pulse: This pulse occurs on your inner wrist.
- Femoral pulse: This pulse originates in the groin, where the leg meets the pubic area.
- Popliteal pulse: You can find this pulse on the back of your knee.
- Posterior tibial pulse: This pulse occurs on the inside of the ankle just below the bony protrusion.
Your pulse is a measure of your blood being pumped through your arteries by your heart. Feeling the vibrations of your blood moving is taking your pulse.
You will need to sit or lie down for your doctor to measure your apical pulse. To find the correct apical pulse location, called the point of maximal impulse (PMI), your doctor will need to use landmarks on your body. These include your:
- intercostals, or the muscles between your ribs
- midclavicular line, or the midpoint of your collarbone
Your doctor will start at your breastbone, or the bony portion of your sternum. Next, they will feel for the second intercostal, or space between your ribs. Finally, they will search for your fifth intercostal and travel to your midclavicular line. This spot will likely be your PMI.
At this point, your doctor will set their stethoscope or use their hands or fingers. They will use their timing device while listening to or feeling your apical pulse for a full minute. Your doctor will count one beat every time your heart pumps in the two-syllable pattern, which we recognize as the “lub dub” sound.
Apical pulse ranges can vary by age. For example, children have faster heart rates than adults. Thus, they will have a different typical apical pulse range. Because doctors measure it when you are sitting or lying down, your apical pulse rate is your resting heart rate.
According to the American Heart Association, an adult’s pulse generally sits between 60 and 100 beats per minute (bpm).
There are various reasons why your apical pulse may be outside the typical range. If your pulse rate exceeds the typical range, your healthcare professional will check for:
- recent physical exertion
- anxiety or stress
- pain or discomfort
- high blood pressure
- low oxygen intake
- bleeding or blood loss
If none of these factors are present or your pulse rate is consistently above or below average, your doctor may proceed with further evaluation.
An apical pulse rate higher or lower than usual for your age group can indicate an underlying medical condition or illness. A high apical pulse could result from heart disease, an overactive thyroid, or heart failure.
Certain medications often cause a low apical pulse. If you take a beta-blocker or antidysrhythmic drug, your heart rate might be lower than usual.
A pulse deficit looks at the difference between your apical pulse and another peripheral pulse point, often your radial pulse. Two people will need to be present to measure the pulses, along with the stethoscope and timing device.
One person will take your apical pulse while the other will take your radial pulse on your wrist. They will measure your heart rate simultaneously for a full minute. Once the minute is complete, they will subtract your radial pulse from your apical pulse.
Your apical and radial pulse rates will be the same if everything is working as it should. Your apical pulse rate will never be lower than your radial pulse rate. If the radial pulse is slower than the apical pulse, that indicates a pulse deficit.
A pulse deficit can indicate a problem with the efficiency of your heart or cardiac function. For example, people with atrial fibrillation — an irregular heartbeat that can cause serious heart problems — tend to have a pulse deficit. Generally, your doctor will order an echocardiogram if you have an apical-radial pulse deficit.
Your apical pulse point is a reliable and noninvasive way to assess your cardiac function. The apical pulse point, located along the lower left portion of your sternum, allows your doctor to measure your heartbeat directly.
An apical pulse score that falls above or below the average range often justifies checking your apical-radial pulse deficit. A deficit could indicate a problem with your heart or cardiac system. Though resting heart rate varies between adults and children, scores outside the typical range coupled with deficits may necessitate an echocardiogram.
Talk with your doctor if you think your pulse rate may be atypical or if you are experiencing other concerning symptoms.