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In the left lateral decubitus position, a diameter greater than 3 cm indicates left ventricular enlargement.

Increased amplitude may also reflect hyperthyroidism, severe anemia, pressure overload of the left ventricle (e.g., aortic stenosis), or volume overload of the left ventricle (e.g., mitral regurgitation).

■ Duration. Duration is the most useful characteristic of the apical impulse for identifying hypertrophy of the left ventricle. To assess duration, listen to the heart sounds as you feel the apical impulse, or watch the movement of your stethoscope as you listen at the apex. Estimate the proportion of systole occupied by the apical impulse. Normally it lasts through the first two thirds of systole, and often less, but does not continue to the second heart sound.

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