The Arterial Pulse

With each contraction ,the left ventricle ejects

a volume of blood into the aorta and on into
the arterial tree
A pressure wave moves rapidly through the
arterial system where it can be felt as the
arterial pulse
 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. Peripheral arteries of the legs :Dorsalis pedis

Posterior tibial
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.
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
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
Femoral Pulse
Press deeply below the inguinal ligament and
about mid way between ASIS and SP
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
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
Posterior Tibial
Curve your fingers behind and slightly below
the medial malleolus of the ankle
Comment on the Pulse
1. Rate
2. Rhythm
3. Volume (amplitude)
4. Comparison of the two sides
5. Special character
6. Condition of the arterial wall
 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 ) or slow
(bradycardia) count in 1 min
*if irregular count at apex
weak beats may not be felt (pulsus
deficit)
Rhythm
Is the rhythm regular or irregular?

If irregular:
- Totally irregular (atrial fibrillation)
- Irregular beats in a basically regular rhythm (premature beats)
Volume (Amplitude)
A--Large amplitude (Bounding pulse)
big difference between systolic and diastolic
BP

* High systolic: increased stroke volume

rigidity of aorta

* low diastolic :aortic regurge

B--Small amplitude (weak pulse)

1- low stroke volume

shock (thready)
severe mitral stenosis

2- Aortic stenosis
C--Variation in amplitude

1-pulsus alternans
2-pulsus paradoxus
Comparison of both sides
Causes of unequal pulse
1. Genetic absence or change in the course of
the radial artery
2. Compression of the vessel
3. Atheromatous plaque
4. Embolus
Special character
Factors affecting the form

Upstroke (rise)
Duration
Downstroke (fall)
Types of Pulses
Collapsing and Water hammer
pulse
Rapid upstroke
Rapid down stroke
High amplitude
Short duration

Found in :Aortic incompetence

Hyperdynamic states: Fever
Anaemia
Thyrotoxicosis
Anacrotic Pulse (Plateau
pulse)
Upstroke is slow with a notch on it
Duration of pulse is prolonged
Amplitude is small
In aortic stenosis
Pulsus Bisferiens
In combined aortic stenosis and regurge
Pulse has 2 peaks:
 Upstroke is sharp and rises high to the first
peak
Falls and rises again to a second peak

A double pulse is felt and seen in the carotid