The apical pulse

The apical pulse is the heart rate heard directly over the apex of the heart — the stethoscope placed at the point of maximal impulse, the fifth intercostal space at the left midclavicular line, and every beat counted for one full minute with the rhythm and the strength noted alongside the rate — and it replaces the peripheral count whenever a peripheral pulse cannot be trusted to represent what the heart is doing: when the radial pulse is irregular, weak, thready or hard to find, when the rate found at the wrist is unexpectedly slow or fast or does not fit the patient's condition, when the patient has a cardiac disease or a rhythm known to produce beats too weak to reach the periphery, when a drug that slows or regulates the heart is about to be given and whether it is given depends on the rate, and in the infant or young child whose peripheral pulses are unreliable — and where a pulse deficit is suspected the apical and radial pulses are counted at the same time by two nurses for the same full minute, the difference between them being the beats the heart produced that the circulation did not carry.