Apical Impulse

 APICAL IMPULSE

Normal :  Fifth left intercostal space at, or medial to the mid-clavicular line (halfway between the suprasternal notch and the acromioclavicular joint)
Absent : D(dextrocardia) ,O (obesity),P( pericardial effusion and tamponade ,pneumothorax,E ( emphysema,effusion)
Heaving : Forceful but undisplaced palpable apical impulse that noticeably lifts your hand . It is noted in LV Pressure overload - Left ventricular hypertrophy, as in hypertension , severe aortic stenosis or Coarctation of aorta
Hyperdynamic : Seen in LV volume overload - AR ,MR,VSD,PDA,High output states
Diffuse : Occupies more than 1 ICS
Seen in Left ventricular dilatation as in AR
Tapping : Represents a palpable
first heart sound seen in Mitral stenosis and is not usually displaced.
Double apical impulse : Hypertrophic cardiomyopathy.

How to Differentiate Hyperdynamic apical impulse and Heaving Apical impulse clinically
Hyperdynamic : Increased Amplitude,Occupy more than 1 intercostal space,Duration of more than >1/3rd but  <2/3rd of the systole
Heaving :
Increased Amplitude,Occupy more than 1 intercostal space,Duration of > 2/3rd of systole

Reference: Macleod's clinical examination -14th ed,Clinical Examination in Cardiology