The apical pulse is a pulse measured by listening to your heart directly through the chest wall, at the spot where the bottom tip of your heart sits closest to the surface. It gives the most accurate reading of your heart rate because you’re hearing the heartbeat at its source, rather than feeling a ripple of blood flow at your wrist or neck. A normal resting apical pulse falls between 60 and 100 beats per minute in adults.
Where the Apical Pulse Is Located
In adults, the apical pulse is found between the fifth and sixth ribs on the left side of the chest, roughly in line with the middle of your collarbone. This spot is sometimes called the point of maximal impulse, or PMI, because it’s where the heartbeat can be felt or heard most strongly. If you place your fingers on your left chest just below the nipple, you’re in the general area.
In children under 7, the heart sits slightly higher in the chest. Their apical pulse is located between the fourth and fifth ribs instead. This difference matters because using the wrong landmark in a child could lead to a weaker or inaccurate reading.
Why It’s More Accurate Than a Wrist Pulse
When you check your pulse at your wrist (the radial pulse), you’re feeling a pressure wave that traveled from your heart through your arteries. That wave can weaken along the way if the heart isn’t pumping forcefully or if there’s vascular disease. The apical pulse bypasses that problem entirely because it picks up each heartbeat directly through a stethoscope pressed to the chest.
Beyond rate, the apical pulse reveals rhythm and strength. A wrist check or a fingertip pulse oximeter can tell you how fast your heart is beating, but it can’t reliably show whether beats are irregular or whether some beats are too weak to push blood effectively. Listening at the apex captures all of that.
How It’s Measured
Measuring an apical pulse requires just a stethoscope and a watch with a second hand. The listener places the stethoscope on the chest at that fifth-intercostal-space landmark and counts heartbeats for a full 60 seconds. The full minute matters. Shorter counts (like 15 seconds multiplied by four) can miss irregular beats that come and go, giving a falsely normal result.
Each heartbeat produces two sounds, often described as “lub-dub.” Together, those two sounds count as one beat. The listener also pays attention to whether the rhythm is steady or skips, and whether the sounds are strong or muffled.
Apical Pulse in Infants and Children
The apical pulse is the preferred way to measure heart rate in infants and children up to about age 5. Young children have small wrists and fast heart rates, making it difficult to feel and count a radial pulse accurately. In hospital settings, apical pulse checks are common for children up to age 18.
Normal heart rates are much faster in young children than in adults. Newborns typically range from 100 to 160 beats per minute. Toddlers (ages 1 to 3) fall between 80 and 130. By adolescence, the rate settles into the adult range of 60 to 100.
What a Pulse Deficit Means
Ideally, your apical pulse and your radial pulse should match. If a provider counts 78 beats per minute at the chest and 78 at the wrist, blood is reaching the arteries with every heartbeat. But sometimes the wrist count comes in lower. The gap between the two numbers is called a pulse deficit.
A pulse deficit signals that some heartbeats are too weak to generate a pulse wave that reaches the wrist. This can happen with irregular heart rhythms like atrial fibrillation, where some contractions are so feeble they don’t push enough blood forward. Detecting a pulse deficit is one of the key reasons providers check the apical pulse rather than relying on a wrist reading alone.
When the Apical Pulse Guides Medication Decisions
Certain heart medications slow the heart rate as part of how they work. Before giving one of these medications, the apical pulse is checked to make sure the heart rate isn’t already too low. If the apical rate is below 60 beats per minute, the medication is typically held and the prescribing provider is contacted. Giving a rate-slowing drug to someone whose heart is already beating slowly could push it into dangerously slow territory.
This is one of the clearest examples of the apical pulse directly influencing a treatment decision in real time.
What a Shifted Apical Pulse Can Reveal
The location of the apical pulse itself carries diagnostic information. When the point of maximal impulse has shifted lower or further to the left than expected, it suggests the heart has enlarged. A displaced apical pulse is considered one of the most specific physical signs of an enlarged heart.
An enlarged heart can result from many conditions: long-standing high blood pressure, coronary artery disease, valve problems, or cardiomyopathy from infections, alcohol use, or other causes. In some cases, the shift is benign, as in athletes whose hearts enlarge from years of intense training. But when a provider notices the apical pulse is not where it should be, it typically prompts further evaluation with imaging. A sustained, forceful impulse that spans more than one rib space is a sign of significant thickening of the heart’s main pumping chamber.