The apical impulse, also known as the apex beat, is the pulse sensed at the fifth intercostal space at the midclavicular line. It is the same pulse assessed when looking for the point of maximum impulse or PMI. An alteration of the apical impulse may indicate cardiomegaly or heart enlargement. It may also imply other conditions such as chest wall deformity or a pulmonary disease.
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It initiates the intrinsic pathway of coagulation.
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Those bones are called Vertebre
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