Answer;
Cardiac enlargement:
- Left ventricular dilation (volume overload) displaces impulse down and to the left ans increases size more that one space.
-A sustained impulse with increased force and duration but no change in location occurs with left ventricular Hypertrophy and no dilation (pressure overload)
- Pulmonary emphysema which makes it non-palpable from the lung sound overriding heart sound.
Step-by-step explanation;
- Apical impulse is a point of maximal impulse; pulsation created as the left ventricle rotates against the chest wall during systole.
- When visible, it occupies the fourth or fifth intercostal space, at or inside the midclavicular line. It occurs during systole (short, normally first 1/2 of systole).
- It is normally 1 ×2 cm in size.