If the patient is in the left lateral decubitus position and the PMI is not laterally displaced, the examiner can suspect that cardiomegaly is not present. The position of the PMI in the left lateral decubitus position must be assessed with the understanding that the normal cardiac impulse is now shifted slightly to the left. If it cannot be felt in the sitting position, the patient should be reevaluated while supine and in the left lateral decubitus position. The PMI is felt in approximately 70% of normal individuals while they are sitting. *Low-frequency cutaneous vibrations associated with loud heart murmurs. Technique for assessing point of maximum impulse A PMI that is laterally displaced or is felt in two interspaces during the same phase of respiration is suggestive of cardiomegaly. The PMI is usually within 10 cm of the midsternal line and is no larger than 2 to 3 cm in diameter. If the apical impulse is not felt, the examiner should move his or her fingertips in the area of the cardiac apex. Only the examiner's fingertips should be applied to the patient's chest in the fifth intercostal space, midclavicular line, because they are the most sensitive for assessing localized motion. Palpation for the PMI is most easily performed with the patient in a sitting position. The examiner should stand on the right side of the patient, with the bed at a level comfortable for the examiner.
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