Palpation of the PMI

LSU Physician Champion - Dr. Najy Masri

Physical Examination – Palpation for the point of maximal impulse (PMI) should be done with the pads of your fingers for best assessment. Patients should be examined in the supine position and the PMI is often better felt with the patient in the left lateral position. The PMI should be evaluated for location, diameter, amplitude, and duration.

Location – 5th intercostal space of the left lateral chest wall in the mid-clavicular line (approximately 9cm lateral to the mid-sternal line) --- Lateral displacement can be seen in volume overload states such as HF

Diameter – 2.5 cm (“size of a penny”) --- Increased diameter seen in volume and pressure overload states such as HF and LVH

Amplitude – Small ---Increased amplitude can be seen in high output states (anemia, pregnancy, sepsis, thyrotoxicosis)

Duration – First two-thirds of systolie ----Sustained duration in HF, HTN, AI