Next, we will evaluate our patient's precordial movement including the location, size and contour. Our patient's precordial movement, the apical impulse, is located in the fifth intercostal space, mid clavicular line and it is dime-sized. In the video and graphic that follow, movement of the cotton swab on the carotid pulse will identify systole. Use this timing reference to evaluate the movement of the other cotton swab placed on the left ventricular apical impulse.