ARTERIAL PULSE

Devika
• Waveform felt by the finger,
produced by cardiac systole, which traverses the
arterial tree in a peripheral direction at a rate much
faster than that of the blood column.
Sites for checking pulse

• Temporal
• Carotid
• Apical
• Brachial
• Radial
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis
Methods of examination
 Characteristics of pulse

Arterial pulse is assessed in the following way :

• Rate
• Rhythm
• Volume
• Character
• Whether felt in all peripheral vessels
• Radio femoral delay
• Condition of the vessel wall
Radial pulse is felt to assess rate and rhythm
Carotid pulse is felt to assess volume and character
Brachial pulse is felt to record blood pressure
Pulse rate

• Pulse rate should be counted for one full minute by

palpating the radial artery .

• Normal pulse rate is 60-100 beats per minute

• Sinus bradycardia—pulse rate < 60 beats per minute

• Sinus tachycardia—pulse rate > 100 beats per minute

• Causes of sinus bradycardia
a) Physiological :
Athletes
old age
sleep
b) Pathological :
Severe hypoxia
Hypothermia
Sick sinus syndrome
Obstructive jaundice
Acute inferior wall infarction
Raised intracranial tension
Heart blocks
Drugs (beta blockers, verapamil, diltiazem, digoxin).
• Causes of sinus tachycardia
a) Physiological : Infants
Children
Emotion
Exertion.
b)Pathological
• Tachyarrhythmias: supra-ventricular, ventricular.
• High output states: anaemia, pyrexia, beriberi
• Acute anterior wall myocardial infarction.
• Cardiac failure, cardiogenic shock.
• Hypovolemia, hypotension.
• Drugs (atropine, nifedipine, beta agonists— salbutamol, catecholamines ,
nicotine)
• Pulse deficit
It is the difference between the heart rate and the pulse rate, when
counted simultaneously for one full minute.

• Causes
Atrial fibrillation : pulse deficit is more than 10 per min
Ventricular premature beats : pulse deficit is less than 10 per min
• Relative bradycardia

Normally for every 1degree fahrenheit increase in temperature, pulse rate

increase by 10 beats per min

When this does not happen condition is known as relative bradycardia

Causes
infections : typhoid, malaria, dengue, Q fever
non infective : lymphoma
 rhythm

• Rhythm is assessed by palpating the radial artery. In certain conditions

rhythm may be irregular.

I. Regularly Irregular Rhythm(predictable)

• Seen in
i. sinus arrhythmia : on inspiration heart rate increases and on expiration
heart rate decreases
ii. Atrial tachyarrhythmia with fixed AV block
iii. Ventricular bigemini, trigemini.
II. Irregularly irregular rhythm

Seen in
i. Atrial or ventricular ectopics
ii. Atrial fibrillation
iii. Atrial tachyarrhythmias with varying AV blocks.
 Pulse volume

• Pulse volume is best assessed by palpating the carotid artery.

• However, the pulse pressure (the difference

between systolic and diastolic BP), gives an accurate
measure of pulse volume.

• Depends on : stroke volume

velocity of ejection
arterial compliance
• When pulse pressure is between 30 and 60 mm Hg,
pulse volume is normal.

• When pulse pressure is less than 30 mm Hg, it is a

small volume pulse.

• When pulse pressure is greater than 60 mm Hg, it is

a large volume pulse.
 Pulse character
• Character is the impression of the pulse waveform obtained
Pulse character is best assessed in the
carotid arteries

• Normal carotid pulse

P WAVE P- Percussion wave

D- Dicrotic wave

D WAVE
Method of
examination of
collapsing pulse
Regular rhythm
 radio femoral delay

• Delay of the femoral compared with the right radial pulse is found in
coarctation of the aorta
Radio radial delay

• Thoracic inlet syndrome

• Aortic arch aneurysm
• Pre subclavian coarctation of aorta
Thank you