Feel for the first intercostal space—the space between the first and second ribs.
If you’re taking the apical pulse on a female, you can use three fingers to feel directly below the left breast. Usually, this same method will work on a man, as well. This allows you to take the pulse without counting the ribs.
In most people, it’s almost impossible to feel an apical pulse using just your fingers. Unless the person is upset or in shock, their apical pulse will likely be too faint to detect without a stethoscope.
Rub the diaphragm (the end of the stethoscope) a bit to warm it up and tap it to make sure that you can hear the noises through the diaphragm. If you can’t hear anything through the diaphragm, check that it is tightly attached to the stethoscope. If it’s loose, you may not hear anything.
Ask the person to face away from you, which can make it easier for you to hear. A heartbeat usually sounds like a galloping horse.
With newborns to three years old, the normal heart rate is 80-140. For four to nine year olds, 75-120 is a normal heart rate. For 10 to 15 years old, 50-90 beats per minute is the normal pulse rate.
One classic example of this is the class of drugs called beta-blockers (like metoprolol). These are commonly used to treat high blood pressure, and can slow down the heart rate. A slow heart beat can be either strong or weak. A strong heart beat is a sign of health.
High blood pressure, heart disease, or infection.
Heavy smokers with lung disease may have the apical pulse displaced to the right. This is because with lung disease, the diaphragm is pulled down to get as much air as possible to the lungs, and in this process the heart gets pulled down and to the right. If you suspect a displaced heartbeat, move your stethoscope to the side and check the pulse again.
For instance, highly trained athletes frequently have very low pulse rates, while someone exercising may have a heart rate higher than 100. In both of these cases, the heart rates are respectively lower or higher than one might expect in most situations, but do not represent a problem. If you’re checking the pulse of an athlete, ask them if they know their average resting heart rate.
For example, a bounding pulse might happen when someone is afraid or has just gone running.
The carotid pulse: Located in the neck on either side of the trachea, the stiff tube in the front of the neck. The carotid arteries are paired, and carry blood to the head and neck. The brachial pulse: Located inside the elbow. The radial pulse: Felt on the wrist at the base of the thumb on the palmar surface of the hand. The femoral pulse: Felt in the groin, in the fold between the leg and the torso. The popliteal pulse: Behind the knee. The posterior tibial pulse: Located at the ankle on the inner side of the leg, just behind the medial malleolus (the bump at the base of the lower leg). The pedal pulse: On the top of the foot, in the center. This pulse is often difficult to feel.
