Your pulse 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.
The apical pulse is one of eight common arterial pulse sites. It can be found in the left-center of your chest, just below the nipple. This position roughly corresponds to the lower (pointed) end of your heart.
Listening to the apical pulse is basically listening directly to the heart. It’s a very reliable and noninvasive way to evaluate cardiac function. It’s also the preferred method for measuring heart rate in children.
How is the apical pulse found?
A stethoscope is used to measure the apical pulse. A clock or wristwatch with seconds is also needed.
The apical pulse is best assessed when you are either sitting or lying down.
Your doctor will use a series of “landmarks” on your body to identify what’s called the point of maximal impulse (PMI). These landmarks include:
- the bony point of your sternum (breastbone)
- the intercostal spaces (the spaces between your rib bones)
- the midclavicular line (an imaginary line moving down your body starting from the middle of your collarbone)
Starting from the bony point of your breastbone, your doctor will locate the second space between your ribs. They’ll then move their fingers down to the fifth space between your ribs and slide them over to the midclavicular line. The PMI should be found here.
Once the PMI has been located, your doctor will use the stethoscope to listen to your pulse for a full minute in order to obtain your apical pulse rate. Each “lub-dub” sound your heart makes counts as one beat.
An apical pulse rate is typically considered abnormal in an adult if it’s above 100 beats per minute (bpm) or below 60 bpm. Your ideal heart rate at rest and during physical activity are very different.
Children have a higher resting pulse rate than adults. The normal resting pulse ranges for children are as follows:
- newborn: 100–170 bpm
- 6 months to 1 year: 90–130 bpm
- 2 to 3 years: 80–120 bpm
- 4 to 5 years: 70–110 bpm
- 10 years and older: 60–100 bpm
When the apical pulse is higher than expected, your doctor will evaluate you for the following things:
- fear or anxiety
- recent physical activity
- hypotension (low blood pressure)
- blood loss
- insufficient oxygen intake
Additionally, a heart rate that is consistently higher than normal could be a sign of heart disease, heart failure, or an overactive thyroid gland.
When the apical pulse is lower than expected, your doctor will check for medication that may be affecting your heart rate. Such medications include beta-blockers given for high blood pressure or anti-dysrhythmic medications given for irregular heartbeat.
If your doctor finds that your apical pulse is irregular, they’ll likely check for the presence of a pulse deficit. Your doctor may also request that you have an electrocardiogram.
Two people are needed to assess the pulse deficit. One person measures the apical pulse while the other person measures a peripheral pulse, such as the one in your wrist. These pulses will be counted at the same time for one full minute, with one person giving the signal to the other to start counting.
Once the pulse rates have been obtained, the peripheral pulse rate is subtracted from the apical pulse rate. The apical pulse rate will never be lower than the peripheral pulse rate. The resulting number is the pulse deficit. Normally, the two numbers would be the same, resulting in a difference of zero. However, when there’s a difference, it’s called a pulse deficit.
The presence of a pulse deficit indicates that there may be an issue with cardiac function or efficiency. When a pulse deficit is detected, it means that the volume of blood pumped from the heart may not be sufficient to meet the needs of your body’s tissues.
Listening to the apical pulse is listening directly to your heart. It’s the most efficient way to evaluate heart function.
If your pulse is outside of the normal range or you have an irregular heartbeat, your doctor will evaluate you further.