impalpable apex beat

Last reviewed 01/2018

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