Pearls for the MRCP:
Apex beat:
Thrusting displaced apex beat is caused by volume overload: an active large stroke volume ventricle eg aortic or mitral regurgitation or left to right shunts.
Sustained apex beat is caused by pressure overload eg aortic stenosis, hypertension.
Tapping apex beat – mitral stenosis.
Diffuse pulsation asynchronous with apex beat – left ventricular aneurysm.
Double or triple impulse may occur in hypertrophic obstructive myopathy.
An impalpable apex beat – obesity, overinflated chest, pericardial effusion, dextrocardia
Paradoxical apical impulse- left ventricular aneurysm
Md. Reazuddin Danish
MRCP (UK)