by Cathy Parkes November 01, 2019 Updated: July 05, 2021
Apical pulse is taken at the fifth intercostal space at the left midclavicular line.
Your pulse, or heart rate, is an important indicator of health and is the vibration of blood as your heart pumps it through your arteries. You can feel your pulse by placing your fingers over a large artery that lies close to your skin. Easy locations to feel your pulse include your neck, base of the wrist, or even between your toes.
The apical pulse is one of the eight common pulse sites on the body. It can be found in the left-center of one's chest just below the fifth intercostal space at the left midclavicular line, corresponding to the lower end of the heart.
Listening to the apical pulse is a non-invasive way to listen directly to the heart and is a very reliable way to evaluate one's cardiovascular system. It’s also the preferred method of measuring the heart rate in children.
The apical pulse is typically taken during a cardiac exam if a patient has a family history of heart disease or has been experiencing symptoms of heart disease including chest pain, shortness of breath, irregular heartbeat, and fatigue.
This method is very popular for use on children when it comes to measuring their cardiac output. It is important when measuring the apical pulse of children and infants to measure for a full minute to ensure accuracy and avoid the possible presence of sinus arrhythmia.
An apical pulse is measured using a stethoscope. You will also need a wristwatch or clock with seconds.
The best way to get an accurate measurement of your patient's apical pulse is by having them sit or lay down. From there you’ll use multiple landmarks on the body to identify something called the point of maximal impulse (PMI).
Starting from the bony point of the breastbone, you will locate the second space between the ribs. You’ll then move your fingers down to the fifth space between your ribs and slide them over to the midclavicular line. The PMI should be found here.
Using a stethoscope, count for 30 seconds and multiply by 2. For example, if you count a total of 34 beats in 30 seconds, their apical pulse will be 68. For an irregular pulse (or if the patient is taking cardiac meds), count for a full minute.
A patient's heartbeat should be at a steady pace with evenly spaced rests between each contraction. For normal adults, your heart’s BPM, or beats per minute, should be between 60-100 bpm, while some very fit athletes can have a resting heart rate of 40-60 bpm.
A child will have a higher resting pulse rate than adults. The ideal range of resting pulse rates in children are as follows:
0 to 1 month: 70–190 bpm
1 to 11 months: 80–160 bpm
1 to 2 years: 80–130 bpm
3 to 4 years: 80–120 bpm
5 to 6 years: 75–115 bpm
7 to 9 years: 70–110 bpm
10 years and older, including adults: 60–100 bpm
There are a few things that can affect an apical pulse and cause irregular readings. Fear and anxiety, a fever, recent physical activity, pain, hypotension, blood loss, and insufficient oxygen intake can all affect an apical pulse measurement.
A consistently higher heart rate can be a sign of heart disease, heart failure, or an overactive thyroid gland. An apical pulse that is consistently lower than expected could mean that medication, such as a beta-blocker for high blood pressure, could be affecting the heart rate, lowering the apical pulse.
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