OBSERVATION OF THE HEARTBEAT
INTRODUCTION
Observation of the heartbeat refers to observation of the pulsation of the left ventricle. In surface anatomy the left ventricle of the heart forms the organ’s left border and produces the apical impulse, that is, the heart systolic beat, which can be felt in the fifth intercostal space, 7 to 9 centimetres from the midsternal line and either on the midclavicular line or just medial to it (Fig. 13.1). Although the pulsation of the left ventricle can always be felt on palpation, it cannot be observed under normal circumstances: it is only when there is a pathological state of the heart that the beat becomes visible on observation. Tangential lighting helps to detect an abnormal pulsation.
Fig. 13.1 Location of the apical beat
The pulsation of Xu Li
The heartbeat of the left ventricle, which can be felt in the fifth intercostal space, was called Xu Li in ancient Chinese medicine, which is another name for the Great Connecting channel of the Stomach. This channel cuts through the diaphragm and the lungs and exits below the left breast producing the heartbeat. It is also said to be the area where the Gathering Qi (Zong Qi) converges. The Gathering Qi itself is said to govern the two channels.
