The normal apex beat is a little below and to the right of the nipple. Lying on either side may change the location slightly either way, A strong impulse should be inquired into; for the reason should be known. The apex beat may be displaced down, or to the right or left. The apex beat must vary in its location. In women the breast development prevents the nipple from being a landmark. In fullness there may be enlargement, and there may be effusion.

By palpating, any undue dullness can be discovered. Pressure over the heart that causes pain indicates either myocarditis or pericarditis. This should not be confounded with intercostal neuralgia or rheumatism, which is strictly local, on or between the ribs.