The apical pulse is found on the left side of the chest, between the fifth and sixth ribs, along an imaginary vertical line that drops straight down from the middle of your collarbone. This spot, sometimes called the point of maximal impulse (PMI), is where the bottom tip of the heart sits closest to the chest wall, making it the clearest place to hear or feel each heartbeat. Here’s how to locate it and take an accurate reading.
Where Exactly to Place the Stethoscope
Start by identifying the midclavicular line. Run your finger along your left collarbone until you find its center point, then trace a straight line down from there toward your ribs. Next, count your rib spaces starting from the top. The small dip just below the collarbone is the first intercostal space (the gap between rib one and rib two). Continue counting downward until you reach the fifth intercostal space, which sits between the fifth and sixth ribs. Where this space crosses the midclavicular line is your target.
You can confirm the spot by pressing gently with your fingernips. A normal PMI feels like a brief, light tap against your fingers, roughly 2 to 3 centimeters across, with one distinct impulse per heartbeat. Once you feel that tap, you know exactly where to place the stethoscope.
Positioning for the Best Sound
The stethoscope must touch bare skin directly. Clothing, even a thin layer, muffles the sound enough to make counting unreliable. Lie flat on your back or turn slightly onto your left side. Rolling to the left shifts the heart closer to the chest wall, which can make the pulse easier to hear, especially if you have a larger chest or more tissue over the area.
For people with breast tissue that covers the fifth intercostal space, lifting the breast upward so the stethoscope rests flat against the chest wall makes a noticeable difference in sound clarity.
Step-by-Step Measurement
Use the flat, circular side of the stethoscope (the diaphragm) rather than the smaller bell. Press it firmly enough to create a seal against the skin, but not so hard that it’s uncomfortable. You’ll hear two sounds in quick succession with each heartbeat: a “lub” followed by a “dub.” Together, that pair counts as one beat.
Count every lub-dub pair for a full 60 seconds. Shortcuts like counting for 15 seconds and multiplying by four work fine for a radial (wrist) pulse, but the whole point of an apical pulse is precision. A full minute lets you catch irregular rhythms, skipped beats, or subtle variations in timing that a shorter count would miss. A normal resting rate for adults falls between 60 and 100 beats per minute.
Why This Pulse Point Matters
Most pulse checks rely on feeling an artery expand at your wrist or neck. The apical pulse is different because you’re listening directly over the heart itself. That makes it the most accurate way to measure heart rate, and the only reliable method for detecting certain rhythm irregularities.
This measurement becomes especially important when someone takes medications that slow the heart rate. If the apical pulse drops below a certain threshold, the dose may need to be adjusted or held. It’s also used when a wrist pulse feels irregular or hard to detect, since every beat the heart produces is audible at the apex, even weak beats that don’t generate enough force to reach the wrist.
Pulse Deficit
Sometimes the number of beats heard at the chest doesn’t match the number of pulses felt at the wrist. The difference between the two is called a pulse deficit. To measure it accurately, two people work together: one listens to the apical pulse with a stethoscope while the other counts the radial pulse at the wrist, both starting and stopping at the same time over 60 seconds. A significant gap between the two numbers suggests that some heartbeats are too weak to push blood all the way to the wrist, which can signal certain types of arrhythmia.
The Location Is Different in Children
In children younger than about 7, the heart sits slightly higher in the chest. From birth through age 3, the apical pulse is located in the fourth intercostal space, between the fourth and fifth ribs. As a child grows, the heart gradually descends, and by around age 7 the apex settles into the fifth intercostal space, the same position as in adults. If you’re checking a young child’s pulse, counting one space higher than the adult landmark will get you to the right spot.
What You Might Feel During Palpation
Before placing the stethoscope, pressing your fingernips to the PMI can reveal useful information beyond just location. A normal impulse feels like a quick, gentle tap that doesn’t linger. If the impulse feels forceful and seems to push outward for the entire duration of the heartbeat rather than tapping and releasing, that can indicate the heart muscle is working harder than usual, sometimes due to thickening of the heart wall or high blood pressure over time. An impulse that feels like two distinct taps in quick succession, rather than one clean tap, may suggest the heart is stiffer than normal and not filling as easily between beats.
These palpation findings are subtle and take practice to distinguish, but they’re a good reason to pay attention to what you feel at the PMI before you start listening.
Troubleshooting a Hard-to-Find Pulse
A few adjustments help when the apical pulse is difficult to locate. Rolling further onto the left side brings the heart closer to the surface. Taking a deep breath and then exhaling fully can reduce the amount of lung tissue between the heart and the stethoscope. Making sure the room is quiet matters more than you might expect, since ambient noise competes with the relatively soft sounds of heart valves closing. If you’re practicing on yourself, sitting upright and leaning slightly forward is another position that can bring the heartbeat closer to the chest wall.