<Table> <Tr> <Td> </Td> <Td> This article needs additional citations for verification . Please help improve this article by adding citations to reliable sources . Unsourced material may be challenged and removed . (December 2009) (Learn how and when to remove this template message) </Td> </Tr> </Table> <Tr> <Td> </Td> <Td> This article needs additional citations for verification . Please help improve this article by adding citations to reliable sources . Unsourced material may be challenged and removed . (December 2009) (Learn how and when to remove this template message) </Td> </Tr> <P> The apex beat (lat . ictus cordis), also called the apical impulse, is the pulse felt at the point of maximum impulse (PMI), which is the point on the precordium farthest outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt . The cardiac impulse is the vibration resulting from the heart rotating, moving forward and striking against the chest wall during systole . The PMI is not the apex of the heart but is on the precordium not far from it . </P> <P> The normal apex beat can be palpated in the precordium left 5th intercostal space, half inch medial to the left midclavicular line . In children the apex beat occurs in the fourth rib interspace medial to the nipple . The apex beat may also be found at abnormal locations; in many cases of dextrocardia, the apex beat may be felt on the right side . </P>

Where is the point of maximal impulse (pmi) normally located