What are the three variations of PMI?

• A. Hyperkinetic, Sustained, and Diffuse
• B. Localized, Soft, and Anomalous
• C. Normal, Amplitude, and Duration
• D. Quiet, Mild, and Prominent

Answer: (A)

The PMI, or Point of Maximal Impulse, can vary in how it feels when you palpate it. The three classic variations to recognize are hyperkinetic, sustained, and diffuse. A hyperkinetic PMI is unusually forceful and brisk, with a higher amplitude than normal, often seen when there’s increased stroke volume or heightened metabolic state—think conditions like anemia, fever, hyperthyroidism, or anxiety. A sustained PMI lasts longer than a normal impulse, indicating a larger or more forceful left ventricle that maintains contraction into a longer part of systole, as seen with LV hypertrophy or dilation. A diffuse PMI is felt over a wider area rather than being localized to a single spot, which can occur with a larger or dilated ventricle and sometimes with volume overload. These three patterns—hyperkinetic, sustained, and diffuse—collectively describe the common PMI variations you’ll encounter in physical exams.