Clinical examination of Radial pulse by Pandian M, Tutor, Dept of Physiology, DYPMCKOP,MH.

Introduction
Ideal graph which represented radial pulse
Importance
Method of examination
Procedure
The following aspects (parameters) of the pulse are studied
Precautions:-
Discussion
Applied aspects
Other peripheral pulses

1. By Pandian M Dept of Physiology DYPMCKOP Clinical examination of radial pulse

2. slo Introduction Ideal graph which represented radial pulse Importance Method of examination Procedure The following aspects (parameters) of the pulse are studied Precautions :- Discussion Applied aspects Other peripheral pulses

3. Introduction Pulse is wave of pressure changes created by ejection of the blood from the heart into aorta and blood column and arterial wall to the periphery. Examination of the radial pulse is an important and essential part of the clinical examination of the patient. Its not only impt for examination of CVS But also for any systemic examination of the patient, Bcoz arterial pulse is one of the vital sign that must be checked with the general examination.

4. Ideal graph which represented radial pulse

5. Importance Examination of radial pulse provides physiological info regarding: The work of the heart The circulatory state and hemodynamics (blood volume, pressure and so on.) The condition of the blood vessel The state of autonomic activity in the body at the moment The mental state of the subject The state of body metabolism and temp

6. Method of examination Principle: with each ventricular contraction the blood is not only pumped into the aorta but also generates pressure waves that are transmitted along the walls of the vessels. These waves expand the arterial wall and the expansion is palpated as pulse.

7. Procedure

8. The following aspects (parameters) of the pulse are studied R ate Rhythm Volume (amplitude) Character Condition of the arterial wall Radiofemoral & Other peripheral pulse.

9. Rate : Count the rate of the pulse, not immediately after placing the finger on the artery, but when the nervousness of the patient subsides. Count the pulse completely one minute . Ideal time is 3 mins and the average of the three may be taken. Pulse deficit – Different bwt Heart rate and pulse rate, pulse rate can never more than the HR

10. Rhythm Rhythm is the spacing order at which successive pulse waves are felt. When the spacing btw all the waves is constant, the pulse is said to be normal. When its not constant, the pulse is said to be irregular. The irregular pulse may have fixed pattern of irregularity (i.e. irregular at regular intervals) or, the irregularity may not have any pattern ( irregularly irregular ).

11. Volume It’s the degree of expansion of the arterial walls during each pulse wave. In physiological conditions, the volume is normal and equal in both sides. Normal volume cannot be described but can only be appreciated by palpating the artery of a normal individual. The pulse volume gives an indication of the SV of LV.

12. Character The abnormalities may be seen in rate, rhythm or amplitude of the pulse. Depending on these changes, various types of abnormal pulses are described. Character of pulse is best appreciated by palpating carotid artery in the neck.

13. Condition of the arterial wall Roll the artery against the bone to asses the thickness of the arterial wall. Normally the arterial wall is not palpable or just palpable But, in old age, it is well palpable (thickened) and may be tortuous.

14. Delay Compare the appearance of the femoral pulse and radial pulse, mark if any delay is present btw them Normally there is no radiofemoral delay, also compare with the radial pulse of opposite side. Other peripheral pulses:- femoral, popliteal , posterior tibial and dorsalis pedis artery of both sides and check the pulse are well felt and appear simultaneously on both sides.

15. Precautions :- Pulse rate – the normal pulse rate is 60 – 100 per minute. (primarily under the control of the ANS). If the HR increases with increased sympathetic activity and decreases with decreased parasympathetic activity. If the HR is more than 100, is called tachycardia and less than 60 is called bradycardia . HR is higher in children & low in elders. HR is higher in inspiration and lower in expiration Discussion :-

16. Applied aspects

17. Conditions that alter HR Tachycardia Physiological Exercise, after eating, anger, emotion and excitement, infants and children, pregnancy and high environmental temp. Pathological Fever, anemia, thyrotoxicosis , beriberi, heart failure, shock seen in hemorrhage, paget’s disease.

18. Bradycardia Physiological Athletes Fear Grief, very old age, meditation and pranayama . Pathological Myxedema Obstructive jaundice, different types of heart block, drugs like propranolol , and digitalis.

19. Rhythm Irregular at Regular Intervals, Seen In sinus irregularity or premature (extra systole)contraction . irregularly irregular– seen in atrial fibrilation

20. Volume Low volume pulse:- Also known as pulsus parvus . Occurs SV heart diseases or pulse pressure diseases. pulsus parvus – is seen in Aortic stenosis , pericardial effusion, pulmonary stenosis , and etc. High volume pulse:- Also known as pulsus magnus Seen in SV is greater & widening of pulse pressure pulsus magnus – is seen in thyrotoxicosis , beriberi, anemia, fever, old age, exercise.

21. Character Different types of abnormal pulses are described in clinical medicine. Common among these’re anacrotic pulse* , diacrotic pulse**, water hammer pulse, & etc water hammer pulse – also called collapsing or corrigan’s pulse. Seen in aortic regurgitation, due to rapid upstroke and down stroke of pulse wave

22. Anacrotic pulse Commonly found in aortic stenosis

23. Dicrotic pulse Commonly seen in febrile states, especially in typhoid fever

24. C – collapsing pulse, D- pulsus parvus , E- pulsus magnus C- steep rise the limp up and down D- Due to aortic incompetence

25. F- pulsus bisferiens , G- pulsus alternans , Alternate beats are strong and weak, due to LVF

26. H- pulsus paradoxus

27. Other peripheral pulses

28. Temporal pulse

29. Facial pulse

30. Carotid pulse

31. Axillary pulse

32. Brachial pulse

33. Apical pulse

34. Femoral pulse

35. Popliteal pulse

36. Posterior tibial

37. Dorsalis pedis

38. References Text book of Medical Physiology Guyton & Hall Hutchinson Clinical Methods Practical Physiology Manual A.K. Jain, C.L. Ghai , G.K. Pal Net source for pictures

39. THANK YOU . . .