Pulses Flashcards
Which pulse do you use to determine rate and rhythm?
Radial pulse
Which pulses are best used to determine character and volume?
Brachial and carotid pulses.
What is a collapsing pulse?
It is associated with aortic regurgitation.
This is a water hammer pulse and can occur in normal physiological states (fever/pregnancy), or in cardiac lesions (e.g. AR/PDA) or high output states (e.g. anaemia/AV fistula/thyrotoxicosis)
How do you assess a collapsing pulse?
First, ensure the patient has no shoulder pain
Palpate the radial pulse with your hand wrapped around the wrist
Raise the arm above the head briskly
Feel for a tapping impulse through the muscle bulk of the arm as blood empties from the arm very quickly in diastole, resulting in the palpable sensation
Should you auscultate or palpate the carotid artery first?
It’s often advised to auscultate the carotid artery for a bruit before palpating, as theoretically palpation may dislodge a plaque which could lead to a stroke
However, if you perform carotid auscultation at this point, remember that the ‘bruit’ may actually be a radiating murmur!
Which range denotes the normal rate?
60-100bpm
Tachycardia >100bpm
Bradycardia <60bpm
Pathophysiology of rhythm
An irregularly irregular pulse occurs in AF or multiple ectopics.
A regularly irregular pulse occurs in second-degree heart block and ventricular bigeminy.
What is ventricular bigeminy?
f you have bigeminy, your heart doesn’t beat in a normal pattern. After every routine beat, you have a beat that comes too early, or what’s known as a premature ventricular contraction (PVC).
PVCs are common and not always harmful
What is a bounding pulse?
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat. This is caused by: CO2 retention Liver failure Sepsis Abnormal or rapid heart rhythms Anaemia Anxiety Long-term (chronic) kidney disease Heart failure Aortic regurgitation Heavy exercise Fever Pregnancy, because of increased fluid and blood in the body Thyrotoxicosis
What can cause a small amplitude arterial pulse?
A small left ventricular volume - in conditions such as shock, tachycardia, left ventricular dysfunction, mitral stenosis
Aortic stenosis - due to obstruction of left ventricular ejection
Severe pulmonary stenosis
What is a slow-rising pulse?
This waveform is characterised by a slow upstroke.
It is particularly prominent in the brachial and carotid pulses.
The time taken to reach the peak is prolonged and the entire wave is flattened and of small amplitude.
Slow rising pulses are less obvious in the peripheral pulses.
Possible causes of a slow-rising (anacrotic) pulse
Aortic valve stenosis - in this condition the rate of ejection of blood into the aorta is decreased so that the duration of the ejection is prolonged. The amplitude of the pulse is diminished as a consequence
Poorly functioning left ventricle may give rise to a slow rising waveform due to slow ejection from the poorly functioning ventricle
What is a bisferiens pulse?
A double pulse is felt due to the backflow of blood in early diastole. The first carotid pulse felt is normal systole, while the second is actually early diastolic due to the regurgitating blood.
This can be caused by:
Aortic regurgitation
Combined aortic stenosis and aortic regurgitation
hypertrophic obstructive cardiomyopathy (HOCM)
Patent ductus arteriosus
Arteriovenous fistulas
Normal hearts in a hyperdynamic state.
What is pulsus alternans?
Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. This suggests: LVF Cardiomyopathy Aortic stenosis
What is a jerky pulse?
This is when the artery is suddenly and markedly distended.
This occurs in HOCM
