Anatomically speaking, the heart’s apex is the bottom tip of the heart, consisting of the left and right ventricles. Conditions affecting the heart’s apex include myocarditis, cardiomyopathy, and heart attack.

Experts define the apex of the heart by the left ventricular (LV) apex and the right ventricular (RV) apex. The left ventricle pumps oxygenated blood to the rest of the body, and the right ventricle pumps returned blood into the lungs.

This article looks into what the apex of the heart is, what it does, and which health conditions can affect it.

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The apex of the heart is at the tip of the left and right ventricles. It sits on the opposite side of this organ from the base of the heart.

The apex of the heart faces toward the left arm and is closer to the front of the body.

With each heartbeat, the apex moves, twists, and impacts the front of the chest, causing an apex beat. A person or clinician can often feel its beats when placing their fingers or hand under the left nipple line.

Learn more about the anatomy of a heart here.

The apex of the heart is the very tip and helps pump or “wring out” blood from the ventricles to the rest of the body (LV apex) or the lungs (RV apex). It does this by helping regulate the right and left ventricles of the heart and allowing them to pump blood upward and out of the heart.

The right ventricle returns blood to the lungs, where the organs oxygenate the blood. The left ventricle brings oxygenated blood all over the body.

Several conditions can affect the heart’s apex. It is important to contact a doctor if a person experiences any symptoms of a heart condition. If they believe they may be experiencing a heart attack, they should seek emergency medical attention.

If a heart attack occurs at the apex of the heart, it can cause the pooling of the blood in the apex. Eventually, a blood clot can form and break off, causing a stroke or other systemic embolism.

Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:

  • chest pain, pressure, or tightness
  • pain that may spread to arms, neck, jaw, or back
  • nausea and vomiting
  • sweaty or clammy skin
  • feeling of heartburn or indigestion
  • shortness of breath
  • coughing or wheezing
  • lightheadedness or dizziness
  • anxiety that can feel similar to a panic attack

If someone has these symptoms:

  1. Dial 911 or the number of the nearest emergency department.
  2. Stay with them until the emergency services arrive.

If a person stops breathing before emergency services arrive, perform manual chest compressions:

  1. Lock fingers together and place the base of hands in the center of the chest.
  2. Position shoulders over hands and lock elbows.
  3. Press hard and fast, at a rate of 100–120 compressions per minute, to a depth of 2 inches.
  4. Continue these movements until the person starts to breathe or move.
  5. If needed, swap over with someone else without pausing compressions.

Use an automatic external defibrillator (AED) available in many public places:

  1. An AED provides a shock that may restart the heart.
  2. Follow the instructions on the defibrillator or listen to the guided instructions.

Other heart-related conditions may also develop that affect the apex of the heart. They each have specific symptoms, diagnostic measures, and long-term management.

Left ventricular apical ballooning syndrome (LVBS), which doctors also refer to as Takotsubo cardiomyopathy, is a type of nonischemic cardiomyopathy. The term nonischemic cardiomyopathy refers to decreased heart function. It results in a sudden temporary weakening of the heart’s muscle tissue.

An older study reports that common symptoms include:

The symptoms often precede an intense physical or emotional event.

Apical ballooning syndrome mimics acute coronary syndromes. Additionally, individuals with Takotsubo cardiomyopathy typically have similar symptoms to a heart attack. However, doctors will consider a person to have a heart attack until they prove otherwise.

Diagnosis

The most common diagnostic tests include an EKG and coronary angiography.

An EKG measures electrical activity and blood troponin levels, which measure proteins that regulate heart contractions. These two factors are markers of heart damage.

In Takotsubo cardiomyopathy, the EKG shows clinical changes that doctors associate with a severe heart attack. Here, there is also an increase in troponin levels, though a heart attack will also produce similar results.

Coronary angiography involves doctors injecting a dye into the coronary arteries to visualize them on a digital image. When healthcare professionals perform one in people with Takotsubo cardiomyopathy, there is no significant coronary artery occlusion, which refers to a blockage.

Other measures include:

  • Ventriculography: This technique can identify ventricular dysfunction and ballooning, similar to coronary angiography but allows visualization of the ventricles.
  • Echocardiography: This method uses ultrasound waves to visualize the heart.
  • Cardiac MRI: An imaging technique to assess the extent of ballooning and dysfunction.

Learn more about heart imaging techniques.

Most individuals usually recover within 1 month. Doctors may also prescribe medications such as:

The management of the disease focuses on pain control and addressing emotional and physical stressors that might have played a role in the condition’s development.

Apical myocardial infarction, a heart attack, results from prolonged reduced blood flow in the left anterior descending (LAD) artery. The LAD is the largest coronary artery running from the heart’s base to the apex.

This condition may mimic LVBS, so a person should receive medical attention to determine the possible cause and treatment.

Diagnosis

An EKG test in a person experiencing an apical heart attack will demonstrate widespread changes, especially when a person has:

Cardiomyopathy is a condition that people may inherit or develop that makes it more difficult for the heart to pump blood through the body effectively. A type of cardiomyopathy, such as stress-induced cardiomyopathy, may cause the apex of the heart to swell.

Cardiomyopathy can cause several symptoms that doctors may use to help diagnose the condition. These symptoms include:

Diagnosis

To diagnose the condition, a doctor may need one or more of the following tests:

Healthcare professionals will likely recommend a person make some lifestyle changes that include:

  • exercise
  • dietary changes
  • quitting smoking if applicable
  • maintaining a moderate weight

Doctors may also prescribe medications, such as beta-blockers, or diuretics, or recommend surgery to treat cardiomyopathy.

Apical hypertrophic cardiomyopathy (AHCM) is a rare form of hypertrophic cardiomyopathy (HCM).

HCM is the term for heterogeneous heart muscle disease. Doctors define this type of disease by detecting left ventricular (LV) hypertrophy without abnormal cardiac loading conditions — theamount of resistance the heart requires to push the blood into the circulatory system.

AHCM has similar symptoms to other heart-related conditions. The main clinical presentations include:

Diagnosis

To diagnose this condition, doctors may perform the following:

  • Cardiac CT scan: This type of test uses iodine which help detects the presence of myocardial fibrosis.
  • Nuclear scintigraphy: Perfusion imaging uses single photon emission CT (SPECT) to identify patterns associated with AHCM.
  • Angiography: This test is an X-ray of the blood vessels.
  • Cardiac MRI: This test can diagnose various heart issues.

Management of HCM involves:

  • assessing symptoms
  • determining mechanisms of symptoms
  • assessing risks
  • family screening
  • improving hemodynamics — how the blood flows through arteries and veins and the forces that affect blood flow

Doctors aim to minimize the risk of:

Therapy can be medical or electrophysiological using a device, or usually a combination of both.

Myocarditis refers to inflammation of the heart. This condition can also affect the apex of the heart along with the rest of the heart.

Symptoms of myocarditis are not specific, meaning the symptoms are the same as several other conditions. However, people may experience:

  • shortness of breath
  • ankle swelling
  • fever
  • fatigue
  • viral infection symptoms such as cough or aches

Diagnosis

A doctor may suspect myocarditis if a person has symptoms, such as trouble breathing and chest pain, without others that may be due to other causes, such as coronary artery disease.

Healthcare professionals may order the following tests when diagnosing myocarditis:

  • MRI
  • heart biopsy
  • blood tests

Doctors may recommend avoiding strenuous activities for up to 6 months after diagnosis or, in severe cases, a temporary heart pump.

The apex of the heart helps regulate the left and right ventricles, which bring blood to the body and the lungs, respectively.

Several heart conditions can affect the apex. It is important to contact a doctor if a person believes they may have a heart condition. Individuals should seek immediate medical attention if they believe they may have a heart attack.