Displaced point of maximal impulse


 * Associate Editor-In-Chief:

Overview
During a cardiac examination, the normal point of maximal impulse (PMI) should be routinely palpated in the left midclavicular line between the fourth and fifth ribs (normally 2-3 cm in diameter). The normal PMI represents the apical impulse of the left ventricle. A displaced PMI sheds light on abnormalities of the heart, and therefore allows for a correct diagnosis

Differential Diagnosis of a Displaced PMI
In alphabetical order


 * Aortic aneurysm
 * Dilated pulmonary artery
 * Left ventricular aneurysm
 * Left ventricular enlargement
 * Left ventricular hypertrophy
 * Massive pleural effusion
 * Right-sided tension pneumothorax
 * Right ventricular dilation
 * Right ventricular hypertrophy

Chest X Ray

 * Chest X-ray is useful for the diagnosis of congestive heart failure, pneumothorax and pleural effusions

MRI and CT

 * MRI and CT scan for patients with aortic dissections or aortic aneurysms

Echocardiography or Ultrasound

 * Echocardiogram assesses the presence/absence of apical aneurysm, wall thickness, ventricular function, chamber size, measurement of pulmonary artery (PA) pressure (indirectly)
 * Transesophageal echocardiogram (aortic dissections or aortic aneurysms)

Treatment

 * Blood pressure control (left ventricular hypertrophy)
 * Observation and diuretics (tension pneumothorax)
 * Treatment of underlying etiology and diuretics (right heart failure)

Surgery and Device Based Therapy

 * Needle decompression and chest tube (pleural effusions)
 * Surgical correction (aortic aneurysm)