This patient’s apical impulse is located in the sixth and seventh intercostal spaces, anterior axillary line, that is, the apical impulse is inferolaterally displaced, and that says the ventricle is dilated. And when one feels the impulse, it is enlarged in size, that silver-dollar size, not the normal dime-size, and that confirms that this is a dilated left ventricle. And when one feels that type of impulse, one thinks dilatation, volume load may be a possibility, such as with leaking valves or shunts and, in addition, you think of poorly contractile left ventricle with pump failure, sometimes a combination of these factors.

Inferolaterally Displaced and Elarged Precordial Impulse

An inferolaterally displaced apical impulse that is enlarged is consistent with left ventricular dilatation and may be seen with volume overload and/or left ventricular failure.