Changes

The '''point of maximum impulse''' (also known as the '''point of maximal impulse''', '''PMI''', '''apical impulse''', '''apex beat''', and lastly the '''A spot''') is the part of the precordium most lateral and inferior from the sternum at which the cardiac impulse can be felt. Because it may not be felt in obese patients (also known as Americans), the '''PMI''' is sometimes referred to as '''pretty much impossible'''.<ref>[http://gomerblog.com/2016/10/new-bmi-classification/ BMI Classification Replaces Word “Obesity” with “American”]</ref><ref>[http://gomerblog.com/2015/12/heart/ Physical Exam Tips: The Heart]</ref>