A sustained apical impulse with a presystolic and an early diastolic component may be felt in a patient with a poorly compliant, dilated left ventricle. The presystolic component is the palpable equivalent of an audible fourth heart sound, while the early diastolic component is the palpable equivalent of an audible third heart sound. In the video, note the sustained apical impulse occurs with the carotid pulse. The presystolic component occurs just before the carotid pulse and the early diastolic component occurs just after the carotid pulse.