Chapter 103

Arterial Pulse

INTRODUCTION
TRANSMISSION OF PULSE
VELOCITY OF TRANSMISSION OF PULSE
PULSE
DELAY IN TRANSMISSION OF
PULSE
METHODS OF RECORDING ARTERIAL
BY MANOMETER
BY DUDGEON SPHYGMOGRAPH
TRANSDUCER
BY ELECTRONIC PULSE
INTERPRETATION OF ARTERIAL PULSE
TRACING
PULSE POINTS
EXAMINATION OF RADIAL PULSE
RATE
RHYTHM
CHARACTER
vOLUME
cONDITION OF THE BLOOD VESSEL WALL
DEDELAYED
AYED PULSE
PULSE
APPLIED PHYSIOLOGY -
ABNORMAL PULSE
PULSUS DEFICIT
PULSUS ALTERNANS
ANACROTIC PULSE
THREADY PULSE OR WEAK PULSE
PULSUS PARADOxUS
WATER HAMMER PULSE
ABNORMAL PULSE IN PATENT DUCTUS ARTERIOSUS
ABNORMAL PULSE IN AORTIC REGURGITATION

interval, at any superfical penpheral artery ke rad

INTRODUCTION
atery at wnst
as the pressu hanges trans-
se Piulse rate s the accurate measure of heat rate.
eral wa and
ugh exceptin condisions like pulses defict (see beiow
ventcle biood s eected TRANSMISSION OF PULSE
sauses csterson of ths
oresSre A essure wave Central arterial pulse s ransmitted to the peripheral
2C E sE
ipc sse e a s t c wa o the aoma t raveis aneres as peripheral arterial pulse. Fomation and
can be tet aher a bief fransmission of pulse wave depends upon the elasts
eeaa
 of blood vessels. Thus, when the walls of the arteries
PULSE TRACING
are more distensible, the pressure rise
is less and so S
ne
fernoral artery
wall
the transmission of pulse is less. When the arterial
or
radial artery puise
Pulse recorded in Peripheral
in old 103 1)
loses its elastic property and becomes rigid peripheral pulse (Fig
as

and the transmission of ypical three nain features

age, the pressure rise is more tracing has
pulse is also more.
Pulse is not transmitted to capillaries because capil 1. Anacrotic Limb limb or
laries are devoid of elastic tissues wave is the
ascending
Anacrotic limb or primary during systoie
rise in pressure
It is due to the
VELOCITY OF TRANSMISSION OF PULSE upstroke.

Average velocity at which the pulse wave is transmitted 2. Catacrotic Limb It

travels faster than downstroke.
varies between 7 and 9 m/sec. Pulse limb or
flow in the body limb is the descending
the blood. Maximum velocity of blood Catacrotic during diastole.
arteries) is only 50 cm/sec. is due to the fall in pressure
(in larger
OF PULSE 3. Catacrotic Notch
DELAY IN TRANSMISSION of pulse tracing
catacrotic limb
short interval from the In the upper part of the catacrotic notch
or
At the arteries, pulse is felt after a known a s
This delay is very small small notch appears. It is of blood
beginning of ventricular systole.
a
the backflow
by
accurate recording. The incisura. This notch is produced
and it can be measured only by semilunar valves at the beginning
the closure of
delay is proportional to the distance from heart.
directly during
slight increase in the
of diastolic period, which produces
Delay of pulse at
to 0.02 second. pressure.
1. Common carotid artery: 0.01
second.
2. Radial artery: About 0.08 Postcatacrotic Waves
4. Precatacrotic and
catacrotic notch is called
METHODS OF RECORDING The wave appearing before the
notch
ARTERIAL PULSE precatacrotic wave.The wave appearing after the
wave
is called postcatacrotic
1 . BY MANOMETER
In animals, pulse is recorded by inserting a cannula PULSE POINTS
connected to a
artery. This cannula is
into the dissected because
device. Usually, pulse is palpated on the radial artery
manometer or any recording
it is easily approachable and placed superficially.
However, arterial pulse can be felt in different areas on
2. BY DUDGEON SPHYGMOGRAPH the body. These areas are called pulse points. Pulse
wrist in such a
Dudgeon sphygmograph is tied
to the points and the area of palpation are given in Table
rests on the skin over radial artery. 103.1.
way that, a small plate
a series of
Movements of arterial wall are magnified by
recorded on a moving strip of smoked EXAMINATION OF RADIAL PULSE
levers and are

This instrument is outdated and it is replaced by Examination of pulse is a valuable clinical procedure
paper.
electronic pulse transducers. Pulse represents the heartbeat. By examining pulse.

TRANSDUCER
3 . BY ELECTRONIC PULSE
Notch
Pulse transducer is placed over finger and tied. This
the
skin.
device throws light on the blood vessel through
Anacrotic imb - -
reflected Catacrotic limb
Sensor of the transducer detects the light rays
from the flowing blood. Alteration in frequency of the ref
lected light rays is amplified and recorded by connecting
The
the transducer to a recording device-like polygraph.
record shows finger pulse volume, which represents
the
artenial pulse tracing.
FIGURE 103.1: Radal pulse tracing
 Chapter 103 Artenial Pulse 651
TABLE 103.1, Pulse points
Pulse point Area of palpation
1. Temporal pulse Over the temple, in front of oar on superficial temporal artery
2. Facial pulse On facial atery at the angle of jaw
3. Carotid pulse In the neck along anterior border of sternocleidomastoid musce on common carotid artery
4. Axillary pulse In axilla on axllary artery
5. Brachial pulse In cubital fossa along modial border of biceps muscle on brachial artery
Over the thumbside of wrist between tendons of brachioradialis and flexor carpi radialis
6. Radial pulse
muscles on radial artery
7. Unar pulse Over the little fingerside of wrist on ulnar artery
8. Femoral pulse In the groin on femoral artery
9. Popliteal pulse Behind knee, in the popliteal fossa on popiteal artery
10. Dorsalis pedis pulse Over the dorsum of foot on dorsalis pedis artery

important information regarding cardiac function such Pulse Rate at Different Age
as rate of contraction, rhythmicity, etc. can be obtained.
In addition, an experienced physician can determine In fetus 150 to 180/min
the mean arterial pressure by hardness of pulse and its At birth 130 to 140/min
amplitude At 10 years of age : 90/min
After puberty 72/min
Method of Examining Radial Pulse

Subject is made to sit comfortably with forearm placed Variations

in mid- or semi-prone position, with wrist slightly flexed. Conditions which alter the heart rate alter pulse rate aiso
The observer must stand by the right side of the subject.
Tips of the middle three fingers (index finger, middle Conditions when pulse rate increases
finger and ring finger) are placed over the radial artery i. Exercise.
below the wrist at the base of thumb. Light pressure is i. Pregnancy.
applied by the fingers until the pulse is felt. If necessary, ii. Emotional conditions.
the fingers are moved around till the pulse is felt.
iv. Fever.
Index finger is used to occlude blood flow from
v. Anemia.
radial artery Ring finger is used to occlude retrograde
flow of blood from ulnar artery through palmar arch. vi. Hypersecretion of
catecholamines
Middle finger is used to assess the pulse. vii. Hyperthyroidism.

Conditions when pulse rate decreases

Observations During Examination of Pulse
i. Sleep
1. Rate.
i. Hypothermia.
2. Rhythm
ii. Hypothyroidism.
3. Character.
iv. Incomplete heart block.
Volume
5. Condition of blood vessel wall.
6 Delayed pulse. 2 . RHYTHM

Rhythm is the regularity of pulse. It refers to interval

1. RATE between beats. Under nomal conditions, the pulse
Pulse rate is the number of pulse per minute. It has to appears at regular intervals. Rhythm of the pulse beco-
be counted at least for 30 seconds. Pulse rate in adults mes irregular in conditions like atrial fibrillation, extra-
is 72 per minute. systole and other types of arrhythmia (refer Chapter 93).
 652 Section 8 Cardiovascular System
Pulse withirregular rhythm is of two radial radial delay
lypes SIcde It is called radioradial delay or
narrowing
i Regularly irregular indicates the
pulse. Or radial-radial inequality. This
Irregularly irregular pulse of large artery due to atherosclerosis

3. CHARACTER APPLIED PHYSIOLOGY

Character denotes the tension on the vessel wall
pro-
ABNORMAL PULSE
duced by the waves of pulse. It is
usually evaluated at 1 . PULSUS DEFICIT
nght carotid artery. Normally, it is not possible to detect
the different waves of the pulse or in which the
slight variations in Pulsus deficit is the abnormal condtion
the character or form of the pulse. However, it becomes pulse rate is less than the heart rate It oCCurs d
more prominent in some abnormal conditions such as fibrillation, when the stroke volume is reduced beou
anacrotic pulse. water hammer pulse, pulsus paradox- of reduced stroke volume, some of the pulse waves

us,etc. which are explained later in this chapter. the peri-

become weak and disappear before reaching
condition in
pheral arteries. Pulsus deficit is the only
4 . VOLUME rate is less than the heart
which pulse rate
Volume is the determination of movement of the vessel
wal. produced by the transmission of pulse wave. It is 2 . PULSUS ALTERNANS
also a measure of pulse pressure. It depends upon the Pulsus alternans is the abnormal condition in which
condition of the blood vessel. the amplitude of every second wave in pulse tracing is
relatively smaller. It is because of the alternate variation
5 . CONDITION OF THE BLOOD
VESSEL WALL in the force of ventricular contraction. However, the
Condition of wall of the blood vessel is assessed rhythm of the pulse is not altered. It is common in severe
by feeling the radial artery and rolling it against the myocardial diseases, paroxysmal tachycardia and atrial
underlying bones. Normally, the wall of the vessel is not fibrillation.
palpable in children and young adults. However, in old
age the wall of the vessel becomes rigid and palpable. 3 . ANACROTIC PULSE
In abnormal conditions like arteriosclerosis, it is felt as Anacrotic pulse is the abnormal pulse, characterized
a hard rope by a slow ascending limb which has a notch called
anacrotic notch. It is produced in aortic stenosis, when
6 . DELAYED PULSE ejection is slow.
Sometimes, the arrival of pulse in certain peripheral
arteries is delayed. It is an important feature to be noted
4 . THREADY PULSE OR WEAK PULSE
because it is useful in diagnosis of certain diseases. Thready or weak pulse is the abnormal pulse in which
Types of delayed pulse the volume of pulse becomes very feeble and is hardly
iFemoral delay felt at the arteries. It usually occurs whenever the stroke
i. Radial-radial delay. volume decreases or when there is severe
vasocon
striction, as in the case of severe hemorrhage or sev-
i. Femoral Delay
ere chills. In these conditions, the
sympathetic activity
While palpating radial pulse and femoral pulse simul increases enormously, leading to general1zed vasocon-
taneously. there is a short delay in the arrival of femo striction.
ral pulse wave. Normally, it is negligible and unnoticed.
However, the prolonged or noticeable delay in the arriv- 5 . PULSsUS PARADOXUS
al of femoral pulse indicates coarctation (narrowing) of
Pulsus paradoxus is the condition when
the
aorta. This delay is called femoral delay, radial-femoral omes very strong and very weak
pulse bec
delay or radiofemoral delay. tion to respiratory cycle.
alternately, in rela
Normally, there is a slight inc
rease in volume of pulse during inspiration and
i. Radial-radial Delay
decrease in volume during expiralion. But, it slight
is hardly
When both the radial pulses are examined simultane noticed However, when itbecomes very
prominent, it
Mly sometimes the arrival of pulse is delayed on one is pathological. This type ot pulse is
noticed in cardiac
 Chapter 103 Arterial Pulse 653
arm of the subjedt and holding t by grasping
raising the
the wrist with paim of the observer
Innominate Left common
artery carotid artery ABNORMAL PULSE IN
Left sublavian PATENT DUCTUS ARTERIOSUs
artery
Right
Patent ductus arteriosus is the perm arer
of orep
pulmonary
ductus arteriosus In fetus. the ings
are
artery Ductus
arteriosus
ing So. the blood which pumped
s g y tre

Left pulmonary diverted systernir a0ra

Aorta intothe pulmonary artery s
artery Durtus arter r s i s
ses
through ductus arteriosus
Pulmonary after birth However in some cases ox sts athrt

trunk 103 2)
closing (Fig
wave is very much aftered
r
his
Pulse pressure
FIGURE 103.2: Diagram showing ductus arteriosus from
condition. Since, the blood flows systemaota
he
to pulmonary artery. after every ventrcular systoie
t decreases the diastol
blood flows out of aorta quickly
imb of the pulse tracing
ic pressure and the catacrotic
140 falls below the level of 80 mm Hg

Flow of blood from aorta to pulmorary artery nc

120 reases the venous return to left

side of the near Sc
left ventricular output increases which n
turn elevates

100 the systolic pressure in arteries Thus puise tracng

above the leve
the peak of the pulse wave s elevated
n this conditon
80 of 120 mm Hg. So. the pulse trac1ng
Aortic
reveals theincreased pulse pressure Fig 103 3
Normal Patent
ductus regurgitation
8. ABNORMAL PULSE IN
arteiosuss
AORTIC REGURGITATION

Aortic regurgitation is the backflow of biood from

ductus acrta
FIGURE 103.3: Radial pulse tracing in patent
arteriosus and aortic regurgitation of
into left ventricle It is common dunng ncompetence
pres-
semilunar valve in aorta It decreases the diastoilc
It is also noticed in
tamponade (refer Chapter 97). sure. Because of backflow of biood. the
left ventrcular
physiological conditions such as deep
breathing. to inCrease utput
filling increases greatly. leading
and systolic pressure Thus. the pulse tracingr aorte
HAMMER PULSE
6. WATER regurgitation is more or less simular to
that n patent duc

Water hammer pulse is the

abnormal pulse, characterized tus arternosus. Only difference Is that
n the tracng dur-

upstroke and an equally rapid downstroke. It aortic regurgitation the ncisura is very mid
And n
by rapid
a ing
or Corrigan pulse. It is
seen
is also called collapsing severe conditions. when the
aortic valve does not close
ductus
aortic regurgitation, patent
in conditions like the incisura is absent (reter Fg
103 3)
is best felt by
arteriosus and arteriovenous fistula. It