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© 1991 Oxford University Press

research-article

The Apex Cardiac Beat: Not a Reliable Clinical Sign in Elderly Patients

E. MULKERRIN, R. SARAN, R. DEWAR, J. R. HARDING, A. J. BAYER and P. FINUCANE

Department of Geriatric Medicine
Department of Radiology, St Woolos' Hospital Newport, Gwent
Department of Geriatric Medicine West Wing, Cardiff Royal Infirmary

To assess its reliability as a marker of cardiomegaly in elderly patients, we compared a clinical assessment of heart size with that calculated from chest radiography. In 100 hospitalized subjects of median age 78 years, the apex beat was palpable in only 35% and its palpability declined with increasing age. Even when palpable, the apex beat had low specificity (74%) and sensitivity (69%) as a marker of cardiomegaly and its positive predictive value (69%) and negative predictive value (74%) were poor. The clinical assessment of heart size in elderly hospitalized patients should be interpreted with caution.

Received February 11, 1991;
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