In this lesson, you’ll learn what the apical pulse is and how it relates to the heart’s functions. You will also explore its location in the body and how to take an apical pulse measurement.
Definition of Apical Pulse
Cardiac function is the ability of the heart to pump blood out of the heart and to the body. Cardiac function can be initially measured by listening to the apical pulse. This is the pulse that can be heard, using a stethoscope, at the apex of the heart. The apex is located at the bottom left of the organ.
This measurement is the actual sounds of the valves in the heart opening and closing. It can be recorded as regular or irregular based on the sounds, rate, and rhythm. Cardiac function is measured as cardiac output (CO). CO is the total amount of blood that is pumped through the heart in one minute. The formula for this is: CO = heart rate (HR) * stroke volume (SV).
Heart rate (HR) is the number of times the heart beats in one minute; normal rates are 60 to 100 beats per minute. Stroke volume (SV) is the amount of blood that the heart pumps out with each beat; the normal amount is 60 to 100 milliliters per beat.
A stethoscope is a device that amplifies sounds. Since the apex of the heart is the lowest part of the heart and pointed downward, it is closest to the outside of the body, and so you can hear the heart sounds best in this location.
There are four valves in the heart – the mitral, tricuspid, aortic, and pulmonary. These heart valves open and close to allow blood to flow through the cardiac chambers. Sounds made by the heart valves opening and closing are represented as lub (when the ventricle, or heart chamber, fills during diastole) dub (when the ventricle contracts during systole). This filling of blood and subsequent contraction produces a heartbeat (or heart rate). This sequence is often referred to as the first heart sound (S1) and second heart sound (S2).
You will need to use landmarks on the body to make sure you have the best location to hear the apical pulse. Expose the chest and run your fingers down the middle of the chest to feel the intercostal space, the area right between your two ribs. Use the illustration here for guidance.
Location to Take Apical Pulse
You need to go to the fifth intercostal space for adults and the fourth intercostal space for a young child or infant. If you place a stethoscope at the apex of your heart, you should be able to listen for the lub dub sounds. You now can find the apical pulse.
Counting and Use of Apical Pulse Measurement
When measuring someone’s apical pulse, make sure the patient is rested before trying to count the apical pulse rate. Have the patient lie down and find the apex of the heart. Ask the patient to breathe through his or her nose with normal breaths. This reduces the breathing sounds so you can hear the heartbeats. Begin the counting of the apical pulse after you start to hear the rhythm. Each lub dub is one beat of the heart. You should count for one full minute, especially if the rhythm is not equal. Irregular rhythm suggests an altered cardiac function.
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