Patient with unusual apical impulse

34 year-old-male with Right side hydropneumothorax, having unusual apical impulse. Suggest the line of treatment??

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Upthurst of apical beat Should be palpable and look for upthurst and any murmur felt May be cardiac or pulmonary As you said there is rt hydropneumothorax that should be analysed if febrile and toxic you may see apical beat Also adv 2decho to look for valvular or any other cardiomyopathy
Thanx dr Pushkar ji Bhomia
Up thurst of apex beat
Hyperdyanmic apical impulse may be due to volume overload state of the heart First put a chest drain for the patient drain the hydropneumothorax and then after stabilization do an echo to r/o regurgitation of left side valve
Tapping apical impulse due to mediastinal shift to left ,due to hydropneumothorax, right
rapid,hyperdynamic impulse which seems to be shifted out of the midclavicular line.