Clinical Examination Arterial Pulse:

Arterial pulse can be examined (palpated) in main peripheral arteries the radial, brachial, carotid, femoral, popliteal, posterior tibial and dorsalis pedis. Redial pulse examination is preferred as it can be easily felt. It is best felt with the tips of the three fingers, slightly compressing the vessel against the underlying bone. Patient’s forearm should be pronated and wrist slightly flexed.

OBSERVATIONS:

Following observations should be made during the examination of arterial pulse.

1. Rate
2. Rhythm
3. Character
4. Volume
5. Condition of vessel wall
6. Presence or absence of delay in femoral and radial pulse.
7. Compared the pulse with other side.

Rate:

Radial pulse is expressed in terms of beats per minute. Beats are counted for full one minute. Causes of increase in pulse rate are anxiety, excitement, execrise, fever and thyrotoxicosis. Causes of decrease in pulse rate are athletes, hypothyroidism heart block.

Rhythm:

Normally the pulse beats at regular interval so decide whether it is regular or irregular. If it is irregular, decide if it is completely irregular, whether the irregularity has a recurring pattern, or whether an otherwise regular rhythm is occasionally interrupted by some slight irregularity. The pulse of atrial fibrillation is completely irregular.

Note if it is regular, irregular, regularly irregular (regular ectopics) or irregularly irregular (atrial fibrillation and atrial flutter with variant block).

Character:

By feeling of radial pulse character of pulse cannot be appreciated. It is felt by palpation of camtld pulse. Normal pulse having p, t, n and d waves, which are identified by sphygmograph.

Abnormal Characters:

• Anacrotic pulse: This occurs in aortic stenosus. There is slow rise in p wave. The pulse is of small volume. This is known as an anacrotic pulse.

• Bisferiens pulse: It is a combination of the slow rising and collapsing pulses occurring when aortic stenosis and incompetence are present.
• Collapsing or water hammer pulse; It is characterised by a rapid upstroke and descent of the pulse wave. It occurs most often in aortic regurgitation. collapsing  character is due to regurgitation of blood from aorta back into the left ventricle or due to abnormal leak from arterial system.
• Pulsus alternans: When ventricle beats strongly then weakly in successive beats of normal rhythm, alternation is present. It happens in case of severe left ventricular damage. ‘

Volume:

This refers to the amplitude  movement 0f the vessel wall during passage of pulse wave. This gives rough guide to pulse pressure which depends onthe stroke volume and the compliance of the arteries.

Causes of abnormal volume of pulse are:

• In shock pulse is weak and thready.
• Pulse is strong and high volume during exercise and old age.

Condition of Vessel Wall:

To assess this sufficient pressure Should be exerted on redial pulse and It should be rolled beneath the fingers against underlying bone.

• Arterial wall cannot be felt or it is soft in young persons.

• It is easily palpable and felt like whip cord due to arteriosclerosis in old people.

Delay of the Femoral Pulse as compared with right radial pulse:

It is found in coarctation of aorta.

Compare the Right Radial Pulse with the Left Side:

This is done to find any delay or to check synchronicity.

How to Describe the Pulse:

72 Per min, regular, good in volume, equal on both the sides, normal character and synchronous on opposite side. No delay of femoral pulse as compared to right radial pulse.