Estimated reading time: 3 minutes
- Arterial pulse : Pressure wave generated by the ejection of blood into circulation from left ventricle
Pulse rate
- Normal pulse rate: 60-100 per minute
- Clinical
- Pulse deficit (Apex-pulse deficit)
- Bradycardia & tachycardia
- Bradycardia : PR <40 per minute
- Tachycardia : PR >100 per minute
Pulse rhythm
- Normal rhythm: Normal sinus rhythm → Regular pulse
- During inspiration : Slight ↑
- During expiration : Slight ↓
- Clinical
- Regularly irregular pulse
- Trigeminy: Every 3rd beat is premature
- Quadrigeminy: Every 4th beat is premature
- Irregularly irregular pulse : Atrial fibrillation
- Regularly irregular pulse
Pulse volume
- Strength of pulse
- Depends upon pulse pressure (SBP – DBP)
Pressure waveform
Pulse character
| Pulse character | Description | Cause | |
| Bisferiens pulse | 2 Palpable pulses, both in systole | Hypertrophic obstructive cardiomyopathy (HOCM) Advanced AR AR + Mild AS | |
| Dicrotic pulse | 2 Palpable pulses, one in systole & one in diastole | Patients on intra-aortic balloon counterpulsation (IABP) | |
| Anacrotic pulse | Interrupted (notch) upstroke i.e. notch on upstroke | ||
| Pulsus parvus et tardus | Slow rising pulse i.e. weak & delayed pulse | Severe AS | |
| Pulsus alternans | Alternating volume of pulse i.e. beat-to-beat variability of pulse amplitude | Heart failure (LVF) | |
| Collapsing pulse (Corrigan’s pulse, Water-hammer pulse, Dancing carotid) | Very high volume pulse with rapid upstroke & rapid downstroke Pulse pressure >60 mmHg | AR Thyrotoxicosis Anemia Pregnancy PDA Beriberi Paget’s disease | |
| Pulsus paradoxus | Inspiratory decrease in SBP >10 mmHg Normally Inspiration ↓ ↓ Intrathoracic pressure ↓ ↑ Venous return to RV + Pooling of blood in pulmonary vessels ↓ ↓ Blood to LA ↓ ↓ Blood to LV ↓ Inspiratory decrease in SBP 3-10 mmHg Pulsus paradoxus Inspiration ↓ Excessive blood in RV ↓ Bulging of Intra ventricular septum into LV ↓ Further decrease in blood to LV | Respiratory distress like Asthma, COPD, Tension pneumothorax Cardiac tamponade Constrictive pericarditis  |
Synchronicity
Radioradial delay
- Unequal pulses in radial arteries of both upper arms
- Cause: SBP difference in both arms >10 mmHg
- Conditions
- Takayasu arteritis
- Subclavian artery atherosclerosis
- Cervical rib
- Aortic dissection
- Pre-ductal coarctation of aorta
Radiofemoral delay
- Unequal pulses in femoral arteries of both lower limbs
- Condition : Postductal coarctation of aorta
