A site for medical students - Practical,Theory,Osce Notes

Arterial Pulse –assessment

Definition of pulse
An alternate expansion and recoil of an artery as the wave of blood is forced through it by the contraction of the left ventricle.
Arterial pulse  is felt by palpating a superficial artery that has a bone behind it.
Counting pulse is an indirect measure to assess heart rate.
Normally pulse rate is equal to heart rate.
Assessment of Pulse;
Pulse Rate
  • Pulse rate is the number of contractions over a peripheral artery in 1 minute.
  • Regulated by the autonomic nervous system through cardiac sinoatrial node
  • Parasympathetic stimulation  will decrease heart rate
  • Sympathetic stimulation  will increases heart rate
  • The normal heart rate in adult is ( 60 – 100 beat/min.)
  • Tachycardia defined as  rapid pulse rate , greater than 100 beat /min.
  • Bradycardia  is defined as  pulse rate below 60 beats / min. in adults.
The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Girls with age 12 and older and women, in general, tend to have faster heart rates than do boys and men
Athletes, such as runners, may have slow heart rates in the 40's and experience no problems.
What are the factors that contribute to increase in pulse rate
  • Pain.
  • Fever.
  • Stress.
  • Exercise .
  • Bleeding.
  • Decrease in blood pressure .
  • Medications as adrenalin, aminophylline
  • Age; as age increases, the pulse rate gradually decreases.
  • Exercise; the pulse rate normally increase with activity
  • Fever; the pulse rate increases in response to the lowered blood pressure which  results from peripheral vasodilatation associated with elevated temperature and because of the increased metabolic rate.
Factors that may slow the heart rate
  • Rest .
  • Increasing age.
  • People with thin body size .
  • Medication as ( digitalis ).
  • Thyroid gland disturbances .
Assessment of Rhythm of pulse:
Rhythm refers to the pattern of beats ,the interval between each beat should be identical. Normal Rhythm of pulse indicate  that beats are identical in force and separated by equal intervals.
Abnormalities in pulse Rhythm: - An irregular pulse rhythm is called arrhythmias.
Intermittent pulse: a type of irregular pulse where a beat dropped either irregular or regular i.e. each 4 beats there is a dropped beat or in the form of periods of normal rhythm broken by periods of abnormal rhythm.
Bigeminal; It consists of two regular beats followed by a longer than normal pause with no beat, and then two regular beats again followed by a pause
What are the common sites for palpating the pulse
Pulse in Head/neck
  • Carotid pulse: located in the neck
  • Facial pulse: located on the mandible (lower jawbone) on a line with the corners of the mouth (facial artery).
  • Temporal pulse: located on the temple directly in front of the ear (superficial temporal artery)
  • The facial artery, about an inch forward of the angle of the jaw.
  • The subclavian artery behind the inner end of the clavicle against the first rib
  • The internal maxillary artery- in front of and slightly below the ear 
Pulse in the upper limb
  •  Axillary pulse: located inferiorly of the lateral wall of the axilla
  • Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants  (brachial artery) .The brachial artery, on the inner aspect of the upper arm, about halfway between the shoulder and the elbow.
  • Radial pulse: located on the lateral of the wrist (radial artery). It can also be found in the anatomical snuff box. At the wrist, is the most commonly used for palpating the pulse rate, because it is easily accessible and it can pressed against the radius bone
  • Ulnar pulse: located on the medial of the wrist (ulnar artery).
Pulse in Lower limb
  • Femoral pulse: located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine (femoral artery).
  • Popliteal pulse: Above the knee in the popliteal fossa, found by holding the bent knee. The patient bends the knee at approximately 124°, and the physician holds it in both hands to find the popliteal artery in the pit behind the knee (Popliteal artery).
  • Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus (dorsalis pedis artery).
  • Tibialis posterior pulse: located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the medial malleolus (posterior tibial artery). It is easily palpable over Pimenta's Point. 
How to check your pulse?
  • You feel the beats by firmly pressing on the arteries, that is located close to the surface of the skin at certain points of the body.
  • Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.
  • Push lightly at first, adding pressure if there is a lot of subcutaneous fat or you are unable to detect a pulse. If you push too hard, you might occlude the vessel and mistake your own pulse for that of the patient.
  • Measure the rate of the pulse (recorded in beats per minute).
  • Count for 30 seconds and multiply by 2 (or 15 seconds x 4).
  • If the rate is particularly slow or fast, it is probably best to measure for a full 60 seconds in
  • order to minimize the error.
  • Pulse: Regularity.Is  assessed by examining the time between beats ,if it is constant it is regular
  • Pulse: Volume should be assessed