AI

M :EXAMI
NATI
ON OFARTERI
ALPULSE.

Art
eri
alPul
se isdefi
nedasr hy
thmicalexpansionofart
eri
alwallduetotr
ansmissionofpressur
ewav e
al
ongthewall
ofarteri
est hatarepr
oduceddur ingeachsystol
eofheart.I
thasveloci
tyofabout6-10m/sec
andshoul
dnotbeconf usedwi t
htheflowofbl oodthathasavelocit
yof0.5m/sec.

PROCEDURE-

Ar
ter
ial
pul
sei
sdet
ect
edbygent
lycompr
essi
ngt
hev
essel
agai
nstsomeunder
lyi
ngst
ruct
urel
i
kebone.

Thesi
teswher
epul
sei
spal
pat
edar
e-

1.Radi
alpul
se

2.Br
achi
alpul
se

3.Femor
alpul
se

4.Car
oti
dpul
se

5.Popl
i
teal
pul
se

6.Dor
sal
i
spedi
spul
se

7.Super
fi
cial
tempor
alpul
se

8.Subcl
avi
anpul
se

9.Post
eri
ort
ibi
alpul
se
 1.Radi
alpul
se-Ther
out
ineexami
nat
ionofar
ter
ial
pul
sei
sdoneont
hisar
ter
ybecause

1.I
tisconv
ienent
lyaccessi
bleasi
tisl
ocat
edi
nanexposedpar
toft
hebody
.

2.Thear
ter
yli
esov
ert
hehar
dsur
faceoft
hel
owerendoft
her
adi
us.

I
tispalpatedwi t
ht heti
poft hreef i
ngerscompr essingthev esselagai
nstt heunderlyi
ngbone.The
subjectforearm shouldbesemi -pr onatedandwr i
stslightl
yf l
exed.Theindexf ingertowardsthehear
t
vari
est hepressureont hearter
y.Themi ddlefi
ngerisusedt ofeelthepulse.Ther i
ngfingeri
susedto
blocktheretrogradepul sati
onsf r
om t hepalmararch.Radi alpulseisusedt oacesst herateandryt
hm
simultaneously.Pal
patet hefemor alpulsetodetectanyr adio-f
emor aldel
ay.

2.
Brachi
alpul
se-

Theart
eryi
scompressedagai
nsthumerusj
ustabovetheantecubi
talfossa,
medi
alt
othet
endonof
bi
scepsmuscl
e.I
tisusedtoacesspul
sechar
acterandtoconfi
rmry t
hm.

3.
Car
oti
dpul
se-

Itshoul
dbepal patedbycompr essi
ngcaroti
dart
eryagainstcervicalv
ert
ebraeatthel
evelofhyoi
dcarti
lage
towardsmedial borderofst
ernocli
edomastoi
dmuscle.Bothcar oti
dsshouldnotbepal
pated
simult
aneouslybecauseofdangerofr educi
ngcerebr
albloodflowwhi chcanleadtosyncope.I
tispal
pated
bestforaccessingpulsecharact
erandtoacessleftv
entri
cularfuncti
on.

4.
Femor
alpul
se-

Iti
spalpat
edov erfemoral
arter
yingr
oinareajustbel
owthei
nguinall
i
gamentinmi
dwaybet weenant
eri
or
superi
oril
i
acspi neandpubicsymphy
sis.I
tisusedtodet
ectr
adiofemoral
del
ayandtoaccessperi
pher
al
vascul
ardiseases.

5.Popl
i
teal
pul
se-

I
tispal
pat
edov erpopl
i
tealar
ter
yandi
smostdi
ff
icul
ttopal
pat
e.I
tisf
elti
npopl
i
teal
fossawi
thf
inger
ti
ps
byfl
exi
ngthekneepassiv
ely.
6.
Post
eri
ort
ibi
alpul
se-

I
tispalpat
edbehi
ndmedi
almal
l
eol
us.I
tisusedmai
nlyt
oaccessper
ipher
alv
ascul
ardi
seasesi
npat
ient
s
wi
thdiabetes.

7.
Dor
sal
i
spedi
spul
se-

I
tispal
patedonthedor
sum off
ootatt
hemi
dpoi
ntbet
weenmedi
alandl
ater
almal
l
eol
iatt
hebaseoff
ir
st
metat
arsalbone.

8.Super
fi
cial
tempor
alpul
se-

I
tispal
pat
edov
ert
hesuper
fi
ci
alt
empor
alar
ter
yinf
rontoft
ragusofear
.

9.Subcl
avi
anpul
se-

I
tispal
pat
edov
ert
hesubcl
avi
anar
ter
yjustabov
ethemi
ddl
eofcl
avi
cle.

OBSERVATI
ONS

1.Rat
e

2.Ry
thm

3.Char
act
er

4.Vol
ume

5.Condi
ti
onofv
essel
wal
l

6.Eual
i
tyont
het
wosi
desi
.e.sy
nchr
oni
ci
ty

7.Radi
ofemor
aldel
ay

1)RATE.

Iti
sex pressedasbeat spermi nute.Normall
ypulseraterangesbetween60-100beatspermin(bpm) .And
averageis72bpm.I tisnor mall
yhi gheri
nchi l
dreni.
e.90-100bpm andlowerinol
dagei .
e.55-
65bpm.
Pulseratenor mall
yincreasesdur ingdeepinspi
rati
onanddecr easesduri
ngdeepexpir
ati
on.Whent his
happensdur ingquietbreathingitiscall
edsinusar r
hythmia,whichisduetoir
radi
ati
onofimpulsesfrom
respir
atorycentertocardiaccent er.

Abnor
mal
i
ties ofRat
eofpul
se

1.Tachy
car
dia

Ani
ncr
easei
nhear
trat
eabov
e100bpm i
sk/
nast
achy
car
dia.

Causes–phy
siol
ogi
cal
:

.
Emot
ional
exci
tement
,ner
vousness,
appr
ehensi
on.

.
Muscul
arex
erci
se

.
Aft
ermeal
s

.
Newbor
n(125-
150bpm)

.
Pregnancy
Pat
hol
ogi
cal

.
Fever:f
orev
ery1degr
eeri
seintemper
atur
e,heartr
ateincr
easesby10-
14bpm.Ther
aisedt
emp.Act
s
di
rect
lyonSAnodeandgener
atemoreacti
onpotenti
alperuni
tti
me.

.
Thy
rot
oxi
cosi
s

.
Atr
ial
flut
terandat
ri
alf
ibr
il
lat
ion

.
Par
oxy
smal
atr
ial
tachy
car
dia(
PAT)

2.
Brady
car
dia-

Decr
easei
nhear
trat
ebel
ow60bpm.

Phy
siol
ogi
calcauses:

.
Athl
etes-
50-
55bpm i
sthehear
trat
eduet
oincr
easedv
agal
tone.

.
Sleepandmedi
tat
ion-HR-bel
ow 60bpm

Pat
hol
ogi
cal
causes:

.
Myxoedemaorhy
pot
hyr
oidi
sm

.
Hear
tbl
ocks

.
Gener
ali
sedweakness

.
Drugsl
i
kedi
git
ali
sandpr
opanol
ol

2)RHYTHM

Normall
ypulserat
efoll
owsatregul
ari
nter
val
i.
e.r
hyt
hm i
sregul
ar.
i
rregul
ari
ti
escanbeei
therr
egul
arl
y
i
rr
egularori
rregul
arl
yir
regul
ar.

Regul
arl
yir
regul
arseeni
next
rasy
stol
eorpr
emat
urebeat
s,at
ri
alf
lut
ter
.

I
rr
egul
arl
yir
regul
arseeni
nat
ri
alf
ibr
il
lat
ion.

3)CHARACTER OR FORM

Itmeanswav eform andvol

umeoft hepulsei.e.whethert
hepulsewavehasanor malrisemai ntenanceor
fall
(it
scont our).
Iti
sbesteval
uatedattherightcaroti
darter
ybecauseitiscl
osestt
ot hehear tandleast
subjectedtodistort
ionanddampi ngi
nthear teri
alt
ree.Si
ncethecontouroft
hepulsewav ecannotbe
usuallyfel
tclearl
ybypalpat
ion,sorecordneedst obedonebyusi ngsphygmographorel ectr
onic
transducer.
Pulsehav i
ngnormalcharact
eriscal l
edcatacrot
icpul
seandi t
str
acingshowsf ol
lowihgwaves:

a)Pur
cussi
onwav
eorAnacr
oti
cli
mb

Thi
sistheshar
pupstrokeduet
otheexpansi
onofar
ter
yduet
ovent
ri
cul
arsy
stol
eandcor
respondst
o
maximum ej
ect
ionphase.

Thedownst
rokei
scal
l
edcat
acr
oti
cli
mb.

b)Ti
dal
wav
e

Thi
swav
eisduet
oel
ast
ici
tyofaor
taandr
epr
esent
sthesl
owej
ect
ionofbl
oodi
ntoaor
ta.
 c) Di
crot
icnot
chandDi
crot
icwav
e

bothareseenindecendingli
mb.Thenot
ch,negati
vewaveisduetorecoi
lofel
asti
caor
tat
hatcausesthe
bloodcolumntomoment ar
il
ysweepbacktowardsthehear
t.Ther
eversefl
owclosest
heaor
ti
cvalveand
reboundsfrom i
ttocausetheposi
ti
vedi
crot
icwave.

Abnor
mal
i
tiesofar
ter
ial
pul
sewav
ear
e:

a)Di
crot
icpul
se:Ther
earetwopal
pabl
ewaves,onei
nsy
stol
eandotheri
ndiastol
e.I
tisseenmost
commonlyi
nlowstr
okevol
umeespeci
all
yint
hosewit
hdi
lat
edcar
diomyopat
hies.

b)Coll
apsi
ngorWaterhammerpulseorCor
riganspulse:I ti
schar
act
eri
sedbyanabr
uptr
iseandsudden
descenti
nanear
lydi
astol
e.I
tisseeninaor
ti
cr egur
gitat
ion.

c)Bisferi
enspulse:
Itisacombi
nati
onofslowrisi
ngandcol
l
apsi
ngpul
seandseeni
nwher
eaor
ti
c
stenosisandincompet
encear
epresentt
ogether
.

d)Pulsusparadoxus:I
nthiscondit
ionpul
sebecomesmal l
erorevendi
sappear
sondeepinspi
rat
ioni
n
pati
entswithlar
geperi
cardi
aleff
usionorsev
ereast
hma.Thepar adoxi
sthatwhil
epul
semaynotbefeltat
thewristbutt
heheartsoundsmayst i
ll
befel
tatper
icar
dium.

e)Pul
susalter
nans:Inthisbeat
sareregul
arbutshowsal
ter
nat
elyl
argeandsmal
lampl
i
tude.I
tisseeni
n
sever
lydi
seasedlef
tventr
icul
arf
ail
ure.

f)Pul
susparvousorslowri
singpulse:I
tissmall
weakpulsewhichri
sessl
owl
yandhasal
atesy
stol
i
c
phase.I
tisseeni
naort
icst
enosis,
leftv
entri
cul
arfai
l
ureandhypovol
umia.

4)VOLUME

Itr
efer
stotheampl
i
tudeofmov
ementofv
essel
wal
ldur
ingpassageofpul
sewav
e.I
tgi
vesi
ndi
cat
ionof
str
okevol
ume.

Abnor
mal
i
tiesofv
olume

a)Lowv
olumepul
se:Pul
sei
sweakandseeni
nshock,
haemor
rhage.

b)Highvolumepul
se:
Pul
sei
sst
rongandofhi
ghv
olume,
seeni
npy
rexi
aanemi
a,pr
egnancyand
thy
rotoxi
cosis.
5)
CONDI
TIONOFTHEVESSELWALL.

Theradialart
eryi
sblockedwi ththeindexf i
nger.
Ther ingfi
ngerfi
xesthevesselaf
teremptyi
ngit
,withthe
middl
ef i
ngertrytopal
pateandr oll
thearteryagainsttheunderl
yingbone.I
nmostoft heyoungpeople,t
he
emptiedarter
yissocompl iantthatitcannotbef el
tasasepar atestr
uctur
e.Howeverthevessel
becomes
pal
pableinmi ddl
eageandi sfel
tasacor dl i
kestructurei
noldageduet oather
oscler
osisandcalci
fi
cati
on.
Thesurfacemayshowi rregulari
tiesandv esselwallmaybet ort
uous.

6)RADI
OFEMORALDELAY

Whenthefemoral
andradial
art
eryar
epalpat
edsimult
aneousl
y,t
heybeatt
oget
her
.INcoar
ctat
ionofaor
ta,
t
hefemoralpul
seisdel
ayedascomparedwit
hradial
pulse.

7)SYNCHRONI
CITY

Compareeachofthement
ionedfeatur
ewit
htheopposi
teside.I
nheal
thypeople,t
hesefeatur
esare
normall
ysameandpulsei
ssy nchr
onousonbothsi
des.I
ftherei
slossofsynchroni
cit
y,i
tindi
cat
esan
obstr
ucti
ontobl
oodfl
ow.

PRECAUTI
ONS

.
Alway
sst
andonr
ightsi
deoft
hepat
ient
.

.
Pat
ientshoul
dbecomf
ort
abl
eandi
nast
ateofphy
sical
andment
alr
est
.

.
Rat
eshoul
dbecount
edf
orf
ull
onemi
nut
e.

OBSERVATI
ONS

RATE 72bpm

RHYTHM Regul
ar

VOLUME Goodv
olume

CHARACTER Cat
acr
oti
c

SYNCHRONI
CITY Pr
esent

RADI
OFEMORALDELAY Nor
edi
ofemor
aldel
ay

CONDI
TIONOFVESSELWALL Notpal
pabl
easacor
d.