The apical pulse is a pulse site on the left side of the chest over the pointed end, or apex, of the heart. It can indicate potential issues with a person’s heart health.
The pulse, or heart rate, is an important indicator of health. A person can feel their pulse on the inside of their neck, at the base of their wrist, and even in between their toes.
An irregular apical pulse may indicate an underlying heart condition. However, a doctor cannot make an official diagnosis based on a person’s apical pulse alone.
In this article, we describe the procedure for measuring the apical pulse. We also outline the health conditions and other factors that can affect the apical pulse.
The apical pulse occurs when the bottom left chamber of the heart, called the left ventricle, contracts.
As the left ventricle contracts, it pumps oxygenated blood into the aorta. The aorta is the artery that carries blood to the rest of the body.
The left ventricle forms the pointed end of the heart, which doctors refer to as the apex. A doctor will listen to or palpate (use their fingertips to feel) the area above the apex when measuring the apical pulse.
The apical pulse provides useful information about a person’s cardiac health. A doctor will usually measure the apical pulse as part of a cardiac exam.
A person may receive a cardiac exam if they have a family history of heart disease or have been experiencing symptoms of heart disease. Examples of such symptoms include:
Apical pulse measurements usually take place while a person is either sitting or lying down.
The doctor will place a stethoscope on the left side of the breastbone, over the apex of the heart. They can also feel the apical pulse at the point of maximal impulse (PMI). The PMI is in the space between the fifth and sixth ribs on the left side of the body.
Once the doctor has found the apical pulse, they will track the number of pulsations or “lub-dubs” that the heart makes in 1 minute.
If the apical pulse is abnormal, the doctor may order one or more of the following tests:
- an electrocardiogram (EKG), which measures the speed and rhythm of a person’s heartbeat
- an echocardiogram, or echo, which uses high frequency sound waves to create moving images of the heart
- a chest X-ray, which uses electromagnetic waves to create detailed images of the heart
A doctor may recommend genetic testing if they suspect that a person has familial hypertrophic cardiomyopathy or another type of inherited heart disease.
In general, the heart should beat at a steady pace, with evenly spaced rests between each contraction.
The normal heart rate ranges for people of different ages are as follows:
- 0–1 month: 70–190 beats per minute (bpm)
- 1–11 months: 80–160 bpm
- 1–2 years: 80–130 bpm
- 3–4 years: 80–120 bpm
- 5–6 years: 75–115 bpm
- 7–9 years: 70–110 bpm
- 10 years and older, including adults: 60–100 bpm
Some well-trained athletes may have a resting heart rate of 40–60 bpm.
The heart rate varies in response to physical, environmental, and emotional triggers.
Some factors that may affect the apical pulse include:
Physical activity
A person’s pulse increases during moderate-to-intense physical activity. The reason for this is that the heart must work harder to pump oxygenated blood around the body.
Air temperature and humidity
Environmental factors, such as air temperature and humidity, also affect the apical pulse.
When cool air surrounds a person, their body naturally radiates heat. When a person is in a hot, humid environment, their body is less efficient at getting rid of excess body heat. As a result, the blood flow reroutes to the skin, placing greater demands on the heart, and this increases the apical pulse.
Emotional triggers
A person’s heart rate increases in response to emotional triggers, such as stress and anxiety.
Stress and anxiety trigger the body’s fight-or-flight response. This physiological reaction occurs in response to perceived danger.
During the fight-or-flight response, the nervous system stimulates the adrenal glands, causing the release of epinephrine (also called adrenaline) and norepinephrine. These hormones trigger temporary increases in heart rate, breathing rate, and blood pressure.
Heart disease or injury
Sometimes, a doctor may discover that a person has a long apical pulse or an extra apical pulse. An abnormal apical pulse can sometimes indicate heart disease or injury.
Long apical pulse
A long apical pulse suggests that the left ventricle is working harder than normal. Over time, the muscles of the left ventricular wall become thicker and less elastic. This change results in a condition called left ventricular hypertrophy (LVH).
In LVH, the heart does not pump blood as efficiently as it should, which can lead to a range of symptoms. These
- chest pain, especially during or after exercise
- heart palpitations
- shortness of breath
- dizziness or fainting
- fatigue
Factors that can contribute to LVH include:
- genetics
- high blood pressure
- malfunctioning heart valves
- heart arrhythmia
- diabetes
Extra apical pulse
People who have LVH may also have an extra apical pulse. This extra pulse occurs as blood flows into the left ventricle.
Other possible causes of a double apical pulse include:
- high blood pressure
- insufficient blood supply to the heart
- a narrow or blocked aorta
- chronic heart disease or heart failure
When measuring a person’s apical pulse, the doctor feels for the pulse directly over the heart.
When a person takes their own pulse, they will usually measure their peripheral pulse. A peripheral pulse is a pulse that occurs in a location away from the heart, where a large vein runs close to the skin.
The radial pulse is one of the most well-known peripheral pulse sites. Its location is over the radial artery that runs close to the skin of the inner wrist.
To measure the radial pulse, a person should:
- Hold out the left hand with the palm facing upward.
- Hold out the first two fingers of the right hand, and place the pads of those fingers on the left wrist, close to the base of the left thumb. There should be a slight indentation in this area.
- Slightly extend or flex the wrist until it is possible to feel a strong pulse.
- Count the number of lub-dubs that occur within a 30-second period, then multiply the total by two to determine the heart rate per minute.
If a person has an irregular apical pulse, their doctor may order an apical-radial pulse deficit assessment. This test requires two healthcare professionals. One measures the apical pulse while the other measures the radial pulse.
After 1 minute of measuring, each professional records the pulse at their respective site. They can then calculate the apical-radial pulse by subtracting the radial pulse from the apical pulse. These two numbers should be the same, which means that a normal apical-radial pulse is zero.
However, when the two numbers are different, it is called a pulse deficit. A pulse deficit can indicate a heart condition called atrial fibrillation (A-fib). A-fib is a type of heart arrhythmia, or irregular heartbeat, that interrupts blood flow to the ventricles.
Measuring the apical pulse is a noninvasive and effective way to assess a person’s heart function.
Several factors, including age, level of physical fitness, and emotional state, can influence a person’s pulse.
If a person has an irregular apical pulse, their doctor may order additional tests, such as a chest X-ray, EKG, or echo. The doctor may also compare the person’s apical and radial pulses.