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The statement that is true about the apical impulse is that its location may be indicative of heart size. The apical impulse, also known as the point of maximal impulse (PMI), is typically felt at the fifth intercostal space, in line with the midclavicular line for most individuals. Variations in the location or size of the apical impulse can provide valuable information regarding changes in cardiac structure and function, including potential hypertrophy or enlargement of the heart.

For example, a displaced apical impulse may suggest an enlarged heart due to conditions such as cardiomyopathy or other heart diseases. Thus, the apical impulse serves as a useful clinical marker for health assessment, reflecting the heart's position and size within the thoracic cavity.

Other statements are less universally applicable. The apical impulse is not palpable in all adults; some individuals, particularly those with a thick chest wall or significant lung disease, may not have a palpable PMI. It occurs with the onset of systole rather than diastole, as the heart contracts, resulting in the apex of the heart coming into contact with the chest wall. Lastly, the apical impulse is typically found at the midclavicular line, not in the anterior axillary line