Let us now evaluate our patient’s precordial impulse. We begin by assessing location and size. I can feel the impulse here with my fingertips. Its location is mid clavicular line, fifth intercostal space, and when I palpate it with my fingertips, I find it to be dime-sized. That is the description of a normal apical impulse.

But, in this clinical setting, the apical impulse, the precordial movement, is not always normal. Not normal in location. On some occasions, ectopic impulses may be felt. That particularly refers to impulses between the normal apical position and the left sternal edge. When you palpate those movements, you think dyskinetic myocardium due to ischemia or infarction.