Clinical Signs Mechanism
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Apex beat: hyperdynamic apical impulse/volume-loaded 134 Apex beat: hyperdynamic apical impulse/volume-loaded DESCRIPTION On palpation of the praecordium, the apex beat will be diffuse (i.e. over an area greater than 3 cm 2 ), with a large-amplitude thrust against the hand that quickly disappears. CONDITION/S ASSOCIATED WITH Classically associated with states of volume overload and hypermetabolic states. 1,3,4 More common • Aortic and mitral regurgitation • Thyrotoxicosis • Sympathetic nervous system activation • Anaemia Less common • Patent ductus arteriosus • Ventricular septal defect MECHANISM/S In hyperdynamic states, the impulse felt is simply an exaggeration of the normal cardiac beat. In volume-overloaded states, the Frank–Starling mechanism produces a more forceful ventricular contraction. SIGN VALUE The hyperdynamic impulse has been shown to be related to increased left ventricular volume. 5 One study demonstrated that an apical impulse over an area greater than 3 cm had a sensitivity of 92% with 91% specificity for an enlarged ventricle (PPV 86% and NPV 95%). 6
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Transcript of Clinical Signs Mechanism
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Apex beat: hyperdynamic apical impulse/volume-loaded 134
Apex beat: hyperdynamic apical impulse/volume-loadedDESCRIPTIONOn palpation of the praecordium, the apex beat will be diffuse (i.e. over an area greater than 3 cm2), with a large-amplitude thrust against the hand that quickly disappears.
CONDITION/S ASSOCIATED WITHClassically associated with states of volume overload and hypermetabolic states.1,3,4
More common Aortic and mitral regurgitation Thyrotoxicosis Sympathetic nervous system activation Anaemia
Less common Patent ductus arteriosus Ventricular septal defect
MECHANISM/SIn hyperdynamic states, the impulse felt is simply an exaggeration of the normal cardiac beat.
In volume-overloaded states, the FrankStarling mechanism produces a more forceful ventricular contraction.
SIGN VALUEThe hyperdynamic impulse has been shown to be related to increased left ventricular volume.5 One study demonstrated that an apical impulse over an area greater than 3 cm had a sensitivity of 92% with 91% specificity for an enlarged ventricle (PPV 86% and NPV 95%).6
