Apical pulse is found in the chest, near the heart. It refers to the pulsations at the apex of the heart. In other words, apical pulse is defined as measure of cardiac function, arrived at by placing a stethoscope at the apex of heart and counting for a minute.
The heart is so located that its apex is towards the left side of the chest pointing downward. It is also called as the point of maximum impulse. Cardiac function is measured by listening to apical pulse with the help of a stethoscope. This sound is the actual sound of the valves when they open and close. Valves take in and pump out blood from the heart. In this process, they emit sound called ‘valves sound’ while pumping.
Cardiac function is measured as cardiac output. It is measured as the total volume of the blood pumped by the heart in one minute.
Heart rate is the number of times the heart beats in one minute. Normal rate is 60 to 100 beats per minute. There are four valves in the heart, mitral, tricuspid, aortic and pulmonary. These valves open and close to allow blood to flow in various chambers of heart. Filling of blood and contraction of heart constitutes one heart beat.
Location of apical pulse
Pulse heard or felt lies over the part of the chest wall that lies over the surface of the heart, generally located at the left mid-clavicular line in the fourth intercostals space. To exactly locate it, anatomical landmarks are used.
Calculation of apical pulse
Feel the first rib by locating the clavicle. The clavicle is also called collar bone. It is felt at the top of the rib cage. Below the clavicle is the first rib. Space between two ribs is called the intercostal space. Locate first intercostals space, which is the space between the first and the second rib. With the fingers running along the chest ribs can be easily felt and visualized. Now locate fifth intercostal space with your fingers by counting the ribs. Fifth intercostals space is located between the fifth and sixth ribs. Now, draw an imaginary line which runs from the middle of the clavicle on the left side through the nipple. This line is called the mid-clavicular line.
The apical pulse can be heard at the intersection of the fifth intercostals space and the mid-clavicular line. Apical pulse can be measured by using a stethoscope. The stethoscope should be taken from the neck and ear piece should be directed outward towards the person. Keep earpiece on ears and hold the diaphragm. Gently rub the diaphragm to warm it and tap it so that you can hear the noise from the diaphragm. Now put stethoscope exactly at the point of apical pulse. A person should breathe normally through the nose so that the heart sound can be heard clearly. Two sound is heard Lub-Dub which is considered as one heart beat. Count how many Lub-Dub is heard in one minute. It is pulse rate or heart rate. Normal pulse rate for adults is 60 to 100 beats per minute. Newborn infants and up to three years age children the normal heart rate is 80-140. For 4 to 9 years old the heart rate is 75 to 120, and for 10 to 15 years old 50 to 90 beats per minute is the normal heart rate.
What is a pulse?
A pulse is a palpable heartbeat. It indicates how an individual’s heart is beating per minute. Pulse rate is often checked during any illness. Normal pulse rate is between 60 to 100 beats per minute. Pulse rate faster or slower than this may indicate some problem or disease but can be considered normal for some individuals. Highly trained athletes possess very low pulse rate. Some doing heavy exercise can acquire the heart rate more than hundred. The heart rate can be lower or higher than expectation but is not a problem.
Pulses can be analyzed by their shapes
Pulses can also be analyzed by shapes of the pulse. Bounding pulse means that it is sharper than the normal case. Beats may be smooth or weak. Weak pulse is an indication that there is a shortage of blood in a blood vessel. In bounding pulse, the blood vessel is not able to accommodate extra blood with the pumping of the heart.
Use of apical pulse measurement
To count the apical pulse rate make sure that the person should lie on the bed. By finding apical pulse you can know whether a person has a pulse deficit. It happens when the apical pulse is different from the other pulse measurement of the body. A person suffering from pulse deficit is an indication of decreased cardiac output. It suggests that the apical pulse is different from the radial pulse, which can be felt below the thumb on a person’s wrist with the help of the index finger. In the case of pulse deficit, two persons are needed to take pulse rate.
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