RADIAL PULSE (2).pptx

pulse

1. Clinical Examination of Radial Pulse …

2. Object : Clinical examination of Radial Pulse Definition : The rhythmic expansion and recoil of the arterial wall, due to transmission of pressure along the wall of arteries, that are produced during each systole of heart, is known as PULSE or the ARTERIAL PULSE.

3. Importance of pulse examination Examination of radial pulse provide physiological information regarding: Working of the heart Circulatory state, blood pressure and blood volume Condition of the blood vessels State of the autonomic activity in the body at that movement Mental state of the subject State of body metabolism and temperature

4. Examination of arterial pulse includes peripheral arteries like: Radial artery Femoral artery Popliteal artery Posterior tibial artery Dorsalis pedis artery Among these routinely, pulse examination is done over Radial Artery, because: It is easily accessible and located over exposed parts of body. The radial artery lies over the hard surface of the lower end of radius.

5. PROCEDURE: Radial pulse is examined by compressing the radial artery against the head of radius. The subject forearm is slightly pronated and wrist slightly flexed. Radial artery is palpated with the tip of 3 fingers: Index finger ( towards heart ) – varies the pressure on the artery. Middle finger – feels the pulse. Distal finger – prevents reflections of pulsations from the palmar arch of arteries .

6. Following observations are made: Rate of pulse Rhythm Character or wave form Volume Condition of vessel wall Equality on both sides

7. 1. Rate Of Pulse expressed as beats per minute In a healthy subject, it indicates the true rate of ventricular systole Count the beats for full one minute. Normal pulse rate range, at rest : 80 20 per minute ( avg 72 per min). Normal Pulse rate is more in children : 90 -110 per min. Normal Pulse rate is less in older : 55 - 65 per min. Tachycardia : increase in pulse rate ( >100 per min. ) Causes of tachycardia- Physiological: pregnancy , exercise , anxiety. Pathological: fever, thyrotoxicosis, arrythmias , shock, anaemia . Bradycardia : decrease in pulse rate ( < 60 per min. ) Causes of bradycardia Physiological: deep sleep , old age , trained persons. Pathological: typhoid fever, hypothyroid, complete heart block.  

8. 2. RHYTHM In a normal healthy person, pulse rate is REGULAR . However, pulse rate increase during deep inspiration and decrease during deep expiration. When this happens during quiet breathing, its known as SINUS ARRYTHMIA , which is due to radiation of impulses from inspiratory center to the cardiac inhibitory center. The rhythm may become irregular either regularly irregular or irregularly irregular due to initiation of ectopic beats, atrial flutter or fibrillation, and various degrees of heart block.

9. 3 . Character Or Wave Form For recording the contours (i.e. character) of the pulse, sphygmograph is used. For this, right carotid artery is palpated as it is closest to the heart and least subjected to distortion.

10. The Normal Pulse Wave Shows Following Components: P : percussion wave it is due to ventricular systole. t : tidal wave (= Predicrotic wave) it is due to elasticity of aorta. n : aortic notch a negative wave due to regurgitation of blood towards the left ventricle from aorta at the beginning of diastole. d : dicrotic wave it is due to return of the same blood volume being reflected back by closed semilunar valves.

11. Types of Abnormal pulse waves: Anacrotic pulse = means 2 upbeats. Seen in aortic stenosis Small volume pulse with slow rising peak. Due to slow ejection of blood from left ventricle. 2. Water hammer or collapsing pulse. Rapid upstroke and rapid descent. Due to regurgitation of blood from aorta back into the left ventricle or abnormal leak from the arterial system. Seen in AR (aortic valve incompetence) or PDA ( patent ductus arteriosus ).

12. 3. Bisferiens pulse Combination of 1 st and 2 nd wave forms i.E. Slow rising and collapsing pulses. 4. Pulses paradoxus Pulse becomes smaller or even disappears at the end of deep inspiration. It is called paradoxus because heart sounds may still be heard on auscultation over precordium at at time where no pulse is palpable at the radial artery. Seen in large pericardial effusion ( also known as cardiac tamponade ). Or in constrictive pericarditis. 5. Pulses alternans Alternate large and small beats. Seen in myocardial infarction when left ventricle is severely damaged.

13. 4 . VOLUME The volume of pulse refers to the amplitude of the movement of the artery during the passage of pulse wave. It is a measurement of : (i) amount of the blood flowing with every beat. (ii) pulse pressure. cause of Low volume pulse : (i) thin, thready pulse due to decrease in stroke volume as in acute shock.

14. 5 . Condition of the vessel wall Normally the arterial wall is not palpable. In the old age, it is well palpable as a cord-like structure, as due to arteriosclerosis and calcification the vessel may become tortous . 6 . Equality On The Two Sides The arterial pulse of one side is always compared with that of the other side for all its features. Normally, there is no difference.

15. PRECAUTIONS The arm should be properly positioned. Count the pulse for full one minute. The subject should relax and rest for a minimum of 5 min. Pulse of both sides should be examined and compared .

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