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Radial pulse
- 2. PULSE ■ Pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. ■ The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the neck (carotid artery), wrist (radial artery), at the groin (femoral artery), behind the knee (popliteal artery), near the ankle joint (posterior tibial artery), and on foot (dorsalis pedis artery). ■ Pulse (or the count of arterial pulse per minute) is equivalent to measuring the heart rate. ■ The heart rate can also be measured by listening to the heart beat by auscultation, traditionally using a stethoscope and counting it for a minute.
- 3. RADIAL PULSE ■ The radial pulse is commonly measured using three fingers. ■ This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches (superficial and deep). ■ Radial pulse is strong, firm, and regular.
- 4. HOW TO MEASURE THE RADIAL PULSE? ■ The 3 middle fingers are used ■ The palmar surface of the fingers overlies the radial artery. 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.
- 6. CHARACTERISTICS: ■ RATE: Normal pulse rates at rest, in beats per minute. The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardias can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting. ■ RHYTHM: A normal pulse is regular in rhythm and force. An irregular pulse may be due to sinus arrhythmia, ectopic beats, atrial fibrillation, paroxysmal atrial tachycardia, atrial flutter, partial heart block etc. Intermittent dropping out of beats at pulse is called "intermittent pulse". Examples of regular intermittent (regularly irregular) pulse include pulsus bigeminus, second-degree atrioventricular block. An example of irregular intermittent (irregularly irregular) pulse is atrial fibrillation.
- 7. ■ VOLUME: The degree of expansion displayed by artery during diastolic and systolic state is called volume. It is also known as amplitude, expansion or size of pulse. . Hypokinetic pulse: A weak pulse signifies narrow pulse pressure. It may be due to low cardiac output (as seen in shock, congestive cardiac failure), hypovolemia, valvular heart disease (such as aortic outflow tract obstruction, mitral stenosis, aortic arch syndrome) etc. Hyperkinetic pulse: A bounding pulse signifies high pulse pressure. It may be due to low peripheral resistance (as seen in fever, anemia, thyrotoxicosis, hyperkinetic heart syndrome, A-V fistula, Paget's disease, beriberi, liver cirrhosis), increased cardiac output, increased stroke volume (as seen in anxiety, exercise, complete heart block, aortic regurgitation), decreased distensibility of arterial system (as seen in atherosclerosis, hypertension and coarctation of aorta).
- 8. ■ FORCE: Also known as compressibility of pulse. It is a rough measure of systolic blood pressure. ■ TENSION:It corresponds to diastolic blood pressure. A low tension pulse (pulsus mollis), the vessel is soft or impalpable between beats. In high tension pulse (pulsus durus), vessels feel rigid even between pulse beats. ■ FORM: A form or contour of a pulse is palpatory estimation of arteriogram. A quickly rising and quickly falling pulse (pulsus celer) is seen in aortic regurgitation. A slow rising and slowly falling pulse (pulsus tardus) is seen in aortic stenosis. ■ EQUALITY: Comparing pulses and different places gives valuable clinical information. ■ A discrepant or unequal pulse between left and right radial artery is observed in anomalous or aberrant course of artery, coarctation of aorta, aortitis, dissecting aneurysm, peripheral embolism etc. An unequal pulse between upper and lower extremities is seen in coarctation to aorta, aortitis, block at bifurcation of aorta, dissection of aorta, iatrogenic trauma and arteriosclerotic obstruction.
- 9. ■ CONDITION OF ARTERIAL WALL: A normal artery is not palpable after flattening by digital pressure. A thick radial artery which is palpable 7.5–10 cm up the forearm is suggestive of arteriosclerosis.