Pulse

Pulse

Definition : Pulse means the expansion and elongation of arterial walls passively produced by the pressure changes in the arteries during systole and diastole of ventricle.

We have described in article :

Characteristics of pulse

Importance of examination of pulse

Causes of irregular pulse

Important causes of absent pulse

Pulse

Characteristics/points to be noted during examination of pulse:

1) Rates : 

  • Normal
  • Tachycardia
  • Bradycardia

2) Rhythm: Regular or irregular

3) Volume: High or low.

4) Character: Normal or abnormal

5) Condition of arterial wall: Thickened in older age

6) Symmetry: It is normally symmetrical in either side

7) Radio-femoral delay: Normally there is no delay. Delay occurs in coarctation of aorta.

8) Peripheral pulse:  Absent in peripheral vascular disease, arterial embolism.

The different types of abnormal pulse.

Importance of examination of pulse:

By examining peripheral pulses. we can diagnose many cardiovascular and systemic abnormalities, such as –

1) Rate: Normal pulse rate is 60-100 beats/minute in adult.

  • Tachycardia:  Pulse rate > 100 beats/min. It is found in exercise, excitement, emotion, anxiety thyrotoxicosis, anaemia, atrial fibrillation, SVT, some other conditions and drugs etc.
  • Bradycardia: Pulse rate<60 beats/min. It is found in athletes, sleep, hypothyroidism, complete heart block, drugs i.e beta blockers, digoxin, raised intracranial pressure etc.

2) Rhythm: 

  • AF.
  • PVC.
  • Send degree heart block.
  • Sinus arrhythmia etc.

3) Volume :

  • High volume pulse: Found in anaemia, pregnancy, thyrotoxicosis, hypoglycaemia, aortic regurgitation etc.
  • Low volume pulse: Found in vomiting, diarrhoea, dehydration, shock, aortic stenosis etc.

4) Character: Some abnormal pulses are-

  • Pulsus alternans: In acute LVF.
  • Slow rising pulse: In AS
  • Collapsing pulse: In AR and all causes of high volume pulse.

5) Condition of arterial wall: Thickening and hardening of arterial wall is found in arteriosclerosis.

6) Symmetry: Radio-radial asymmetry is found in subclavian artery stenosis, aortic dissection etc.

7) Radio-femoral delay: Delay occurs in coarctation of aorta. check regular pulse rate

The causes of irregular pulse.

Causes of irregular pulse:

1. Regularly irregular pulse:

  • Sinus arrhythmia.
  • Second degree heart block (Mobitz type 1).

2). Irregularly irregular pulse: 

  • Atrial fibrillation.
  • Frequent extra-systoles (ventricular ectopics, atrial ectopics).

or

Causes of irregular pulse:
  1. Atrial fibrillation.
  2. Ventricular extrasystoles / ectopics.
  3. Sinus arrhythmia.
  4. Atrial extrasystoles / ectopics.
  5. Atrial flutter with variable response.
  6. Second-degree heart block with variable response.

Important causes of absent pulse.

Important causes of absent pulse:  A reduced or absent pulse indicates an obstruction more proximally in the arterial tree, caused usually by-

  1. Peripheral vascular disease.
  2. Thromboembolism.
  3. Atherosclerosis
  4. Coarctation of the aorta (causes symmetrical reduction and delay of the femoral pulses compared with the radial pulses).

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