Let us now together evaluate our patient's chest wall movement. When I place my hands on our patient's chest I feel movement in two areas, in the apical area as well as at the left sternal edge. Let's address the apical area first. To begin with, we want to know the exact location at the apex at which we feel the impulse, and this impulse is felt in an inferolaterally displaced area, it's more like the sixth and seventh intercostal space anterior axillary line than the more normal mid clavicular line fifth intercostal space. The second observation at the apex is that this impulse is enlarged. It isn't a dime or even a quarter size, it's getting to a half dollar size impulse. It's a large impulse inferolaterally displaced at the apex.
Graphic
An inferolaterally displaced apical impulse that is enlarged is consistent with left ventricular dilatation and may be seen with volume overload and/or left ventricular failure.