thrusting displaced apex beat is caused by volume overload: an active large stroke volume ventricle eg aortic or mitral regurgitation or left to right shunts.
sustained apex beat is caused by pressure overload eg aortic stenosis, gross hypertension.
tapping apex beat - mitral stenosis.
diffuse pulsation asynchronous with apex beat - left ventricular aneurysm.
double or triple impulse may occur in hypertrophic obstructive myopathy.
an impalpable apex beat - obesity, overinflated chest, pericardial effusion. Also consider dextrocardia.
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