Image:Apex_beat.Algorithm for classification of the<unk>  characters Lateral and/or inferior displacement of the<unk>  usually indicates enlargement of the heart, called cardiomegaly. The<unk>  may also be displaced by other conditions: * Pleural or pulmonary diseases * Deformities of the chest wall or the thoracic vertebrae Sometimes, the<unk>  may not be palpable, either due to a thick chest wall, or conditions where the stroke volume is reduced; such as during ventricular tachycardia or shock. The character of the<unk>  may provide vital diagnostic clues: * A forceful impulse indicates volume overload in the heart (as might occur in aortic regurgitation) * An uncoordinated (dyskinetic)<unk>  involving a larger area than normal indicates ventricular dysfunction; such as an aneurysm following myocardial infarction * A pulse deficit between the PMI and periphery may occur in some arrhythmias, such as premature ventricular contraction or atrial fibrillation. Sustained<unk> , namely prolonged upward cardiac force during systole in a physical exam, can be seen in some chronic conditions such as hypertension and aortic stenosis, especially in elderly and females. An algorithm for the classification of some common<unk>  characteristics is shown in the image
Apex beat
Parasternal heave
Loop mark
Isotropic bands
J wave
Spike-and-wave
Fusion beat
Stenvers projection