Method Of Exam
* Simultaneously palpate both radial pulses.
* Note the rate, rhythm, character, amplitude and compare both pulses.
* Feel the pulse with one finger.
* To evaluate character of pulse - compress brachial artery against humerus and let up part way to feel percussion and tidal peaks.
* Raise the patient's forearm and feel for a bounding pulse by feeling with the flat of your palm.
Normal:
* Pulse is symmetrical, regular and between 60-90 per minute.
* You have to learn to appreciate the character and amplitude of the normal pulse.
Abnormal Finding
* Rate
o Bradycardia: Less than 60/min (Myxedema, heart block, raised IC tension, obstructive jaundice)
o Tachycardia: Faster than 100/min. (Sinus tachycardia, PAT, atrial flutter, ventricular tach)
* Rhythm
o Irregular: (Sinus arrhythmia, extra systoles, atrial fib, pulses bigemini)
o Alternating weak and strong pulse:
+ Pulses bigemini: Normal beat alternating with extra systole (Dig toxicity)
+ Pulses alternans: Normal beat alternating with low amplitude beat
* Amplitude
o Slow small sustained (Aortic stenosis)
o Large bounding pulse: Water hammer pulse: (Aortic insufficiency, high output states, slow heart rates)
o Double systolic peak: Bisferiens pulse (Aortic regurgitation)
o Decrease in amplitude during inspiration: Paradoxical pulse Exaggerated in (Pericardiac tamponade, obstructive lung disease)
* Compare
o Missing or feeble on one side: (Prior cath, Takayasu's disease, subclavian steel syndrome)
* Grading Pulse
o 4=Normal
o 3=Slightly diminished
o 2=About half
o 1=Barely palpable
o 0=Absent
Knowledge Base
* Surface anatomy of radial and brachial artery
* Physiology of pulse
* Diseases altering pulse characteristics
* Cardiac arrhythmias
