We shall next evaluate our patient's precordial movement. When I assess the chest wall, I feel movement only in one area and that area is at the apex and the location is mid clavicular line fifth intercostal space. Now, I want to assess the size of this movement. It is definitely enlarged. It's not a dime sized, normal type movement, it's more like a quarter size. Normal position, enlarged apical impulse. This is fully consistent with underlying left ventricular hypertrophy.
Apex location and size
The normal location of the apical impulse is the fifth intercostal space at the mid clavicular line. It may be enlarged in patients with left ventricular hypertrophy.