PULSE.pptx

Pulse

1. PULSE BY Dr.G.sireesha Diploma family medicine

2. DEFINATION PULSE WAVE is a wave form that is felt by the finger produced by cardiac systole, which traverse t he arterial tree in a perepheral direction at a rate much faster than that of blood column .

3. artery Time at which pulse wave arrives after CARDIAC systole CAROTID BRACHIAL FEMORAL RADIAL 30 MILLISECONDS 60 MILLISECONDS 75 MILLISECONDS 80 MILLISECONDS

4. ARTERIAL PULSE ASSESED IN FOLLOWING WAYS 1. RATE 2.RHYTHM 3.VOLUME 4.CHARACTER 5.WHETHER FELT IN ALL PEREPHERAL PULSES 6. RADIO FEMORAL DELAY Radial pulse is felt to asses the rate and rhythm Carotid pulse is felt to asses the volume and character Brachial pulse is felt to record blood pressure. 7. CONDITION OF THE VESSEL WALL

5. PEREPHERAL PULSES NECK ( carotid artery ) WRIST ( Radial artery ) KNEE ( Popliteal artery ) GROIN ( Femoral artery ) FOOT ( D orsalis pedis , posterior tibial artery ) ABDOMEN ( Abdominal aorta ) .

6. PULSE RATE Pulse rate should be counted for 1 full minute or 60 seconds by palpating the radial artery Normal pulse rate – 60 to 100 /min Sinus bradycardia -<60 / min Sinus tachycardia - > 100 / minute.

7. CAUSES OF SINUS BRADYCARDIA PHYSIOLOGICAL PATHOLOGICAL Athletes sleep Severe hypoxia Hypothermia Sick sinus syndrome Myxoedema Obstructive jaundice Acute inferior wall infarction Raised intra ocular pressure Raised intracranial tension Heart blocks Drugs (beta blockers ,verapamil, diltiazem , digoxin)

8. CAUSES OF SINUS TACHYCARDIA PHYSIOLOGICAL PATHOLOGICAL Infants Children Emotion E xertion Tachyarrythmias -SVT, VT High output states- anemia,pyrexia , beriberi, thyrotoxicosis,pheochromocytoma , av fistula, acute anterior wall MI, cardiac failure , cardiogenic shock , hypovolemia , hypotension, Drugs :atropine , nefidipine , beta agonists – salbutamol, thyroxin, catecholamines , nicotine , caffeine.

9. PULSE DEFICIT It is the difference between the heart rate and pulse rate , when counted simultaneously for one full minute . CAUSES: Atrial fibrillation , Ventricular premature beats .

10. DIFFERENTIATING FEATURES BETWEEN VPC AND ATRIAL FIBRILLATION VENTRICULAR PREMATURE BEATS ATRIAL FIBRILLATION PULSE DEFICIT : LESS THAN 10 / MIN a ‘ wave in jvp -Present On exertion ; decreases or disappears Rhythm ; short pause(NORMAL beat and vpc ) Followed by a Long pause( following vpc ) > 10 / MIN Absent. Persists or inceases Pauses are variable and chaotic .

11. Ventricular premature beats

12. RHYTHM Rhythm is assessed by palpating the radial artery. In certain conditions rhythm may be irregular . Regularly irregular rhythm atrial tachyarrythmias ( PAT and atrial flutter ) with fixed av block Ventricular bigemini , trigemini IRREGULARLY IRREGULAR Atrial or ventricular ectopics Atrial fibrillation

13. IRREGULARLY IRREGULAR Atrial or ventricular ectopics Atrial fibrillation Atrial tachyarrythmias ( PAT and atrial flutter with varying AV block.

14. PULSE VOLUME It is best assessed by palpating the carotid artery . Pulse pressure ( the difference b/w the systolic and diastolic), gives an accurate measure of pulse volume . Pulse pressure b/w 30 to 60 is normal If its is < 30 - small volume pulse if it is > 60 - large volume pulse Pulse volume depends on stroke volume and comliance

15. PULSE CHARACTER It is best assesed in carotid arteries Hypokinetic pulse : small weak pulse (small volume and narrow pulse pressure) Causes Cardiac failure shock mitral stenosis aortic stenosis

16. ANACROTIC PULSE( parvus et tardus ) A low amplitude pulse with slow rising and late peak Eg : severe valvular aortic stenosis

17. HYPERKINETIC PULSE A high amplitude with a rapid rise pulse ( large volume and wide pulse pressure). Causes High output states – anemia , pyrexia , beriberi Mitral regurgitation Ventricular septal defect .

18. Collapsing pulse ( watter hammerpulse )or corrigans pulse . Large volume pulse with rapid upstroke ( systolic pressure is high ) .and a rapid downstroke ( diastolic pressure is low ) . Causes Patent ductus arteriosis . Aortic regurgitation Arterio venous fistula Rupture of sinus of valsalva Thready pulse is seen in shock , jerky pulse seen in HOCM .

19. PULSES BISFERIENS It is a single pulse wave with two peaks in systole . best felt in brachial and femoral artery , it is due to ejection of rapid jet of blood through the aortic valve . CAUSES aortic stenosis and aortic regurgitation Severe aortic regurgitation HOCM Dissection of aorta .

20. PULSES DICROTICUS Single pulse wave with one peak in systole and one peak in diastole due to very low stroke volume with decreased perepheral resistance . Causes Left ventricular failure typhoid fever Dehydration Dilated cardiomyopathy cardiac tamponande .

21. PULSES ALTERNANS Alternating small and large volume pulse in regular rhythm Best appreciated by palpating radial and femoral pulses Causes Severe left ventricular dysfunction It will follow the paroxysmal tachycardia Coupled premature ventricular beats also mimic pulses alternans , here rhythm is irregular.

22. PULSES BIGEMINUS a pulse wave with normal beat followed by a premature beat and a compensatory pause , resulting in alternation of the strength of the pulse. E g ; digitalis toxicity

23. PULSES PARADOXUS It is a exaggerated reduction in strength of arterial pulse during normal inspiration or an exaggerated inspiratory fall in systolic pressure of more than 10 mm hg during quite breathing. Causes Cardiac tamponande Constrictive pericarditis Airway obstruction – acute severe asthma S vc obstruction

24. REVERSE PULSES PARADOXUS: Inspiratory rise in arterial pressure . Causes Hypertrophic obstructive cardiomyopathy Intermittent positive pressure ventilation A trioventricular dissociation

25. RADIO FEMORAL DELAY Delay of the femoral compared with right radial pulse . Eg : coarctation of aorta

26. Thank you