Which abnormal conditions may affect the location of the apical impulse?

Cardiac enlargement:

- Left ventricular dilation (volume overload) displaces impulse down and to the left ans increases size more that one space.

-A sustained impulse with increased force and duration but no change in location occurs with left ventricular Hypertrophy and no dilation (pressure overload)

- Pulmonary emphysema which makes it non-palpable from the lung sound overriding heart sound.

your answer is c! hope this : )