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The normal PMI is usually located near the mid-clavicular point at intercostal space 5.Left 2nd intercostal pulsations? (dilated pulmonary artery).Right 2nd intercostal pulsations? (aneurysm of ascending aorta).Is there a parasternal heave? (right ventricular hypertrophy).Is it single (normal) or a double impulse (e.g.Normally 5th intercostal space near the mid-clavicular line.Checklist of questions when examining PMI:.Somtimes, it will be difficult to palpate the PMI in certain conditions such as extreme tachycardia or shock.Along with palpating for near the apex, you should also palpate both lower parasternal, pulmonary, aortic, suprasternal and epigastric regions for a complete exam.When palpating for the PMI, your finger pads are more sensitive than finger tips.Retraction of chest wall: seen in biventricular hypertrophy or constrictive pericarditis.Left 2nd (or 3rd) intercostal pulsation: less common, can be seen with a dilated pulmonary artery.Right 2nd intercostal pulsation: may indicate an aneurysm of ascending aorta.Can also be normally seen with emphysema, children or a scaphoid abdomen and the very thin.Epigastric & subxiphoid movements: usually seen in with right ventricular hypertrophy, right ventricular dilation or an abdominal aortic aneurysm.Lateral displacement of the PMI (to left): usually seen in an enlarged heart (also seen in right large pleural effusion, right tension pneumothorax and left-sided pulmonary fibrosis).
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The normal PMI is usually located inside the mid clavicular point at intercostal space 5 (see figure below).Prior to observation, have your subject lay flat, you should observe the pulsations from the PMI from the side of the subject. It is best seen in thin-chested patients. Observation of the PMI can be challenging.