Apical Pulse: What It Is & How to Check It

The apical pulse, also known as the precordial impulse, is a site on the chest where you can feel the heartbeat. The apical pulse can provide information about heart rate, rhythm, size, and location. Some abnormalities of the heart's structure can cause changes in the apical pulse.

This article discusses how to locate and interpret the apical pulse.

Senior woman holding chest

Science Photo Library / Getty Images

How to Check Apical Pulse

Other pulse sites are felt by placing the finger over a medium or large artery.

The apical pulse, on the other hand, is a more direct way to feel the pulse, since you can directly feel the left ventricle's contraction at this site. With each heartbeat, blood is ejected out of the left ventricle into the blood vessels to carry oxygen and nutrients throughout the body.

The best position to find the apical pulse is to lay down on your left side with your head resting on your left arm. Then:

  1. With the palm side of your right arm, locate the center of the collarbone (clavicle) and bring your hand down about five rib spaces. Although breast anatomy varies, the apical pulse location is typically located below and to the left of the nipple.
  2. You may need to move breast tissue aside to locate the apical pulse.
  3. The pulse location may vary as your lungs fill with air while breathing, so it can be helpful to palpate the area after exhaling fully.
  4. Once you locate the area with your hand, try to use just the pointer and middle finger to narrow down the area, known as the point of maximal impulse (PMI).
  5. Notice the size of the area, the rate of the pulse, and how many impulses you feel with each heartbeat. Count the pulse for a full minute for the best accuracy.

Pulse Sites

The apical pulse is one of eight common sites to feel the pulse. Each site can provide information about heart rate, and some sites can indicate when blockages affect blood flow to a particular area of the body. The other pulse sites include:

  • Carotid pulse: Felt in the neck to the side of the trachea (windpipe)
  • Radial pulse: Felt just below the wrist on the side nearest the thumb
  • Brachial pulse: Felt in the flexor crease of the elbow
  • Femoral pulse: Felt in the groin
  • Popliteal pulse: Felt behind the knee
  • Dorsalis pedis pulse: Felt on the top side of the foot, about midway between the ankle crease and the space between the first and second toes
  • Posterior tibialis pulse: Felt in the inner ankle just behind the ankle bone

These pulse sites are important because they may be easier to feel, and they can also indicate problems with blockages in blood vessels. For example, pulses in the leg, which include the popliteal, dorsalis pedis, and posterior tibialis pulses, may be diminished or absent in peripheral artery disease.

Advantages of This Pulse Site

While other pulse sites give information about heart rate and heart rhythm, they are located further away from the heart, so what you're feeling is the blood vessels filling with blood from the heart's contraction.

When feeling the apical pulse, you are directly feeling the contraction of the heart itself. Some advantages of the apical pulse site include the ability to gain information about the size and location of the heart, as well as potential abnormalities in the heart.

Results

Location

The location of the apical pulse can vary in the following circumstances:

  • Pregnancy
  • Mass in the chest that causes displacement of the heart
  • Enlarged heart
  • Thickened heart muscle
  • Dextrocardia, a rare condition in which the heart is located on the right side of the chest

Target Ranges

You can use the apical pulse to calculate the heart rate in beats per minute (bpm). Count the number of beats in 15 seconds and multiple by four to get bpm. Or, count for a full minute for better accuracy.

At rest, 60-100 bpm is considered a normal heart rate. In some cases, a heart rate below 60 or above 100 can still be normal.

 Heart Rate (beats per minute)  
 <60 Bradycardia 
 60-100  Normal rate
 >100  Tachycardia

Rhythm

The apical pulse can give information about the heart's rhythm. In normal cases, the rhythm is regular, and may have slight variation with respiration. An irregular rhythm is a sign of an arrhythmia, such as atrial fibrillation.

Apical Pulse Size

The size of the apical pulse should be no larger than a dime. A larger area can indicate an enlargement of the heart, such as a cardiomyopathy.

Apical Pulse Duration and Force

The apical pulse should feel like a tapping movement.

Extra Apical Pulse

In a structurally normal heart, the apical pulse should have a single impulse with each heartbeat. Feeling two or three impulses with each heartbeat can indicate abnormalities in the heart's structure.

For example, those with hypertrophic cardiomyopathy, which causes thickening of a portion of the heart muscle, may feel a double or triple impulse.

People with problems of the aortic valve that result in severe regurgitation may feel a double impulse.

Factors That Affect Apical Pulse

The apical pulse can be affected by things that alter the size of the heart and the way that blood moves in and out of the heart, including:

  • Cardiomyopathy, or heart muscle problems
  • Valve problems such as narrowed (stenotic) or leaky (regurgitant) valves
  • Heart rhythm abnormalities

Atrial Fibrillation

One of the most common arrhythmias that can be felt on the pulse is atrial fibrillation, which is often referred to as "Afib." In atrial fibrillation, the heart rhythm is irregular, because the electrical impulses for the heartbeat are occurring erratically. Atrial fibrillation increases the risk of fast heart rate and stroke. While atrial fibrillation can affect anyone, some common risk factors for atrial fibrillation include:

  • Advancing age
  • High blood pressure
  • Other types of heart abnormalities, such as heart valve problems
  • Obstructive sleep apnea
  • Alcohol use

When to See a Healthcare Provider

Any abnormalities in your pulse should be discussed with a healthcare provider. By feeling your pulse and listening with a stethoscope, your healthcare provider can confirm if an abnormality exists.

Further studies like heart imaging tests or heart rhythm tests may be recommended.

If you notice abnormalities in your pulse, such as an irregular pulse, you should inform your healthcare provider. Pay attention to any symptoms like lightheadedness, dizziness, racing heart, or activity intolerance. If any concerning symptoms such as chest discomfort, shortness of breath, or fainting occur, seek immediate medical attention.

Summary

The apical pulse is an important pulse site that can provide information about heart size, location, rate, and rhythm. It is located on the left side, down five rib spaces from the middle of the collarbone.

Some structural heart abnormalities, such as cardiomyopathy and valve problems, can cause characteristic findings in the apical pulse. If you discover abnormalities in your pulse rate, discuss them with your healthcare provider.

A Word From Verywell

Some people may have difficulty locating their apical pulse, but don't be discouraged if you can't. Apical pulse is just one way to measure your heart's functioning. If you experience pulse abnormalities, contact your healthcare provider to discuss possible causes.

Frequently Asked Questions

  • What is the normal apical pulse rate?

    A normal pulse rate is between 60 and 100 beats per minute (bpm). However, depending on activity level, a lower or higher pulse may be normal for an individual. For example, it is not uncommon for young, healthy athletes to have a lower resting heart rate. A higher heart rate can be normal during exercise or emotional stress.

  • What are the landmarks for apical pulse?

    The collar bone and ribs are landmarks for finding the apical pulse. In most adults, the apical pulse is along a line from the middle of the collarbone and down five rib spaces. This is known as the fifth intercostal space at the mid-clavicular line.

  • Where is the easiest place to measure pulse?

    The apical pulse can be difficult to locate in some people due to breast or adipose tissue on the chest. The easiest place to measure pulse is often at the carotid artery, which is located in the neck to either side of the windpipe or trachea.

Was this page helpful?
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lapum JL, Verkuyl M, Garcia W, St-Amant O, Tan A. Apical pulse.Vital Sign Measurement across the Lifespan - 1st Canadian Edition; 2018.

  2. American Heart Association. Target heart rates chart.

  3. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;76:e159–240. doi:10.1161/CIR.0000000000000937

  4. American Heart Association. Who is at risk for atrial fibrillation (AF or AFib)?.