The arterial pulse
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The document discusses the arterial pulse, including: 1. The pulse is a wave felt by fingers produced by cardiac systole that travels through arteries faster than blood flow. Different arteries have different time lags from cardiac systole. 2. The pulse provides important information about heart function, circulation, and arterial health. It can help detect arrhythmias and diagnose conditions like aortic regurgitation and heart failure. 3. The pulse should be examined in multiple locations and compared between sides. Features like rate, rhythm, volume, and characteristics provide clues to cardiovascular conditions. Certain pulse types indicate specific problems like aortic stenosis or mitral regurgitation.
The arterial pulse
- 1. Dr. Nisheeth M Patel M.D (Medicine) ARTERIAL PULSE
- 2. Pulse: The pulse is a wave form that is felt by fingers and produced by cardiac systole which travels through the peripheral arterial tree in peripheral direction at a rate more faster than that of blood columm. Time lag from cardiac systole: Carotid: 30ms Radial: 80ms Femoral: 75ms Brachial: 60ms
- 3. IMPORTANCE: Also called the mirror of heart Information about arterial wall condition Rough estimation of SBP n DBP State of heart n circulation Detect and diagnosis of arrythmia Diagnosis in case of AR and acute LVF
- 4. The arterial pulse should be examined in all 4 limbs and both sides of the neck 1. Radials 2. Brachials 3. Carotids 4. Femorals 5. Popliteals 6. Temporal 7. Facial 8. Peripheral arteries of the legs :Dorsalis pedis Posterior tibial
- 5. How to feel the Pulse The Radial pulse: The 3 middle fingers are used The palmar surface of the fingers overlies the radial A. and encircles the wrist At first the artery is completely occluded, then gradually release the pressure until maximum feeling of the pulse wave is perceived.
- 6. The Carotids The patient lies down with the head of the bed elevated 30 degrees Carotid pulsations may be visible just medial to sternomastoid Place the left thumb on the right carotid A. in the lower third of the neck at the level of the cricoid cartilage, just inside the medial border of the sternomastoid and press posteriorly Never press both carotids at same time
- 7. Brachial Artery Rest the patient arm with elbow extended palm up Use the thumb of the opposite hand Cup your hand under the patient elbow Feel the pulse just medial to biceps tendon
- 8. Femoral Pulse Press deeply below the inguinal ligament and about mid way between ASIS and SP
- 9. Popliteal Pulse Patient knee should be flexed –leg relaxed Place the finger tips of both hands so that they meet in the middle line behind the knee and press them deeply in the popliteal fossa
- 10. Dorsalis Pedis Feel the dorsum of the foot just lateral to the extensor tendon of the big toe If you cannot feel the pulse, explore the dorsum of the foot more laterally
- 11. Posterior Tibial Curve your fingers behind and slightly below the medial malleolus of the ankle
- 12. Comment on the Pulse 1. Rate 2. Rhythm 3. Volume (amplitude) 4. Force 5. Tension 6. Comparison of the two sides 7. Special character 8. Condition of the arterial wall
- 13. Rate Rate of the pulse at radial artery Normal at rest :60-90 beat / min * if regular: count in 15 sec x 4 * if fast (tachycardia ) *slow (bradycardia) count in 1 min *if irregular count at apex weak beats may not be felt (pulsus deficit) Apex pulse deficit: > 10 suggestive of AF
- 14. Rhythm Is the rhythm regular or irregular? 1. Normally regularly regular 2. Sinus arrhythmia: phasic irregularity with respiration, 3. Irregular: 1. Regularly irregular: 1. PAT with Fixed AV Block 2. Atrial flutter 3. Ventricular bigeminy or trigeminy 2. Irregularly irregular: 1. APCs, VPCs 2. AF 3. PAT with Varying degree of block
- 15. Volume (Amplitude) Degree of expansion between systole and diastole Measurement of pulse pressure Hyperdynamic : (high PP, SV) Anxiety Exercise CHB AR Fever Anemia Thyrotoxicosis AVF Beriberi Hypovolemic: (low PP, SV) Shock CHF Chronic CP Hypovolemia Stenotic Valvular disease Mycarditis Cardiomyopathies
- 16. Force and tension: Force Indicates SBP High in : ISH, AR PDA, Hyperdynamic states: Low in: Shock, Cardiac failure, Stenotic Valuvular lesion, Cardiac Temponade Tension: Indicates DBP
- 17. Comparison of both sides Causes of unequal pulse 1. Genetic absence or change in the course of the radial artery (anomalous radial artery) 2. Compression of the vessel 3. Atheromatous plaque 4. Embolus
- 19. Anacrotic Pulse (Pulsus Tardus): Slow rise, slow fall Duration of pulse is prolonged Amplitude is small Lazy in character (Tardus) In aortic stenosis Dicrotic Pulse: One peak in systole, one in diastole Myocardial disease with reduced CO and TPR LVF, DCM Cardiac Tamponade Dehydration
- 20. Collapsing and Water hammer pulse corriagan, bounding pulse Rapid upstroke Rapid down stroke High amplitude Short duration Causes: Aortic incompetence PDA Hyperdynamic states: Fever, Anaemia, Thyrotoxicosis, pregnancy and AV fistula
- 21. Pulsus Bisferiens Pulse has 2 peaks: two peaks in systole d/t ejection of rapid jet of blood AS + AR Severe AR HOCM A double pulse is felt and seen in the carotid
- 22. Pulsus Parus: Small volume pulse Low CO A/w Tachycardia, thready pulse Physiological: cold, anxiety Vessel occlusion CoA of Aorta Severe Hypotension (Shock) Severe AS PS MI Severe PAH
- 23. Jerky pulse: Small volume & collapsing HOCM Severe MR AR with LVF Pulsus alterans: Alternate large and small volume pulse LV Failure Cardia Arrythmias Pulsus bigeminus: Pulse wave with normal beat f/b VPCs f/b compensatory pause Digitalis toxicity
- 24. Pulsus paradoxus: Exaggerated decrease in strength of arterial pulse during inspiration, Inspiratory fall of SBP >10mmHg Cardiac temponade Constrictive pericarditis Acute asthma SVC obstruction Reverse pulsus paradoxus: HOCM IPPV AV dissociaton
- 25. Thank You…