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Pulse
Cardiovascular | Reference | Pulse
Ref: Pulse
  1. Rate
  2. Rhythm
  3. Character
  4. Delays
  5. Surface anatomy of pulses
Rate
  • <60: bradycardia
  • >100: tachycardia
Rhythm
  • Regular
  • Regularly irregular
  • Irregularly irregular
Character
  • Bounding pulse:
    • CO2 poisoning
  • Collapsing pulse, aka 'water hammer pulse':
    • Aortic regurgitation
    • Heart block
    • PDA 
  • Plateau pulse:
    • Aortic stenosis
  • Pulsus alterans [alternate strong, weak beats]:
    • LVF
  • Pulsus paradoxus [volume decreases on inspiration more than normal: by >10mm Hg]:
    • Constrictive pericarditis
    • Tamponade
    • Severe asthma
  • Small volume:
    • Aortic stenosis
    • Shock
    • Pericardial effusion
Delays
  • Radioradial delay
  • Radiofemoral delay: test in pts with HTN or ejection systolic murmur:
    • Coarctation of aorta
Surface anatomy of pulses
  • Radial
    • Palmar side of wrist, between flexor carpi radialis tendon and radius.
  • Brachial
    • Cubital fossa, medial to biceps tendon.
  • Carotid
    • Just lateral to upper border of thyroid cartilage.
  • Superficial temporal:
    • Anterior to ear as crosses temporal bone's zygomatic process.
  • Abdominal aorta:
    • In midline, at umbilicus pressing into abdomen.
    • Use caution if large AAA, to avoid rupture.
  • Femoral
    • Below inguinal ligament, midway between ASIS and pubic symphysis [not pubic tubercle].
    • May be reduced or absent in arteriosclerotic dz.
  • Popliteal
    • Flex knee before palpating.
    • In midline, on popliteal side of lower end of femur.
    • Most difficult one to palpate.
    • Alternative method: Dr's one hand on pt's knee, other hand under knee. Push flexed knee downwards [into extension] until can feel popliteal.
  • Posterior tibial
    • Posterior, inferior to medial malleolus, between flexor digitorum longus and flexor hallucis longus.
  • Dorsalis pedis
    • Lateral to extensor hallucis longus, over tarsal bones.
    • Palpate with 3 fingers along artery.
    • May be reduced or absent in peripheral vascular dz.
  • For JVP, See JVP Reference.