Abnormal findings can occur in the pulse rate, rhythm, volume, character, vessel walls, and radiofemoral delay. Tachycardia is a pulse rate over 100 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions. Bradycardia is a pulse rate under 60 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions. An irregular pulse can be occasionally, regularly, or irregularly irregular and caused by conditions like extrasystole, ectopic beats, arrhythmias, and atrial fibrillation. Other abnormalities include high or low pulse volume caused by physiological or pathological conditions, varying volume seen with

2. ABNORMAL FINDINGS IN
PULSE
Abnormality can be in the:
 Rate
 Rhythm
 Volume
 Character
 Condition of vessel wall
 Radiofemoral delay

3. ABNORMAL FINDINGS IN
PULSE RATE
1.Tachycardia(Pulse Rate>100 bpm)
2.Bradycardia(Pulse Rate<60 bpm)

4. TACHYCARDIA
Sinus rhythm Arrhythmia
Exercise Atrial Fibrillation
Infants Atrial flutter
Excitement/Anxiety VentricularTachycardia
Pheochromocytoma
Fever
Hyperthyroidism
MEDICATION:
Ca channel blockers(Nifedipine)
Sympathomimetics(e.g. salbutamol)
Vasodilators

5. BRADYCARDIA
Sinus rhythm Arrhythmia
Sleep Carotid Sinus hypersensitivity
Athletic training Sick Sinus Syndrome
Hypothyroidism Second-Degree heart block
MEDICATION: Complete heart block
Beta-blockers
Digoxin
Verapamil, Diltiazem

6. ABNORMAL FINDINGS IN RHYTHM
If Irregular:
Occasionally irregular
Regularly Irregular
Irregularly Irregular

7. CAUSES OF AN IRREGULAR PULSE
Occassionally Irregular Pulse
• Extrasystole
Regularly Irregular Pulse
• Ectopic beat occuring at a regular interval
• Second degree atrioventricular block
• Sinus arrhythmia
Irregularly Irregular Pulse
• Atrial Fibrillation
• Multiple ectopics

8. PULSE APEX DEFICIT
Difference in heart rate and
pulse rate
Atrial Fibrillation (>10/min)
Multiple ectopics (<10/min)

9. ABNORMALITIES IN PULSE VOLUME
HighVolume Pulse
LowVolume Pulse
VaryingVolume

10. High Volume Pulse
Physiological causes:
Exercise
Pregnancy
Advanced Age
Increased Environmental
Temperature

11. Pathological causes
• Arteriosclerosis
• Aortic regurgitation
• PDA
• Arteriovenous fistula
• Fever
• Thyrotoxicosis
• Anaemia
• Beri-Beri
• Complete heart block
• Cirrhosis liver

12. Low Volume Pulse
Causes:
 LeftVentricular Failure
 Hypovolemia
 Peripheral arterial disease
 Shock
 Severe Aortic Stenosis
 Pericardial Effusion

13. Varying Volume
 Combination of low, normal or high
volume pulse in varying manner
 Seen in:
Atrial fibrillation
VentricularTachycardia

14. CONDITION OF VESSEL WALL
Can be:
Normal-Soft
Thickened-firm to hard and cord-like
Elderly due to artherosclerosis

15. CHARACTER OF PULSE
 Collapsing pulse
 Slow rising pulse
 Pulsus bisferiens
 Pulsus parvus et tardus
 Pulsus bigeminus
 Pulsus alternans
 Pulsus paradoxus
 Anacrotic pulse
 Dicrotic pulse

16. Collapsing pulse/Water-hammer
pulse/Corrigan’s pulse

17. Collapsing pulse
 Sharp rise
 Ill-sustained
 Sharp fall
 Wide pulse pressure(>80mmHg)
High volume collapsing pulse in:
Aortic regurgitation
PDA
Normal volume collapsing pulse in:
Mitral Regurgitation

18. Mechanism
 In aortic regurgitation, during diastole:
Left ventricle receives
normal pulmonary venous return+portion of blood
ejected into the aorta => large stroke volume-
vigorously ejected=> rapidly rising carotid pulse

19. Collapses in early diastole – backflow through
aortic valve
Exaggerated at the radial artery by liftng the
arm.

21. Slow Rising Pulse
 Gradual upstroke with a reduced peak
 Occur late in systole
 Seen in severe aortic stenosis

22. Mechanism
Fixed obstruction restricts the rate at which
blood can be ejected from the left ventricle.

23. Pulsus Bisferiens
 Increased pulse with double systolic peak
seperated by a distinct mid-systolic dip.
 Causes:
Aortic regurgitation
Concomitant aortic stenois and regurgitation

25. Pulsus Parvus et Tardus
 Weak and delayed pulse
 Seen in conditions with:
 diminished left ventricular stroke volume
Narrow pulse pressure
Increased peripheral vascular resistance
Aortic stenosis

27. Pulsus bigeminus
 Regular alteration of pulse pressure
amplitude.
 Caused by premature ventricular
contraction that follows each regular beat
 Occurs in:
AV block
Sinoatrial block withVentricular Escape

29. Pulsus alternans
 Beat-to-beat variation in pulse volume with a
normal rhythm.
 Rare
 Occurs in :
Advanced heart failure
Toxic myocarditis
ParoxysmalTachycardias
Following Premature beat

31. Pulsus Paradoxus
 Exaggeration of the normal variability of
pulse volume with breathing.
 Inspiratory decline in systolic pressure
greater than 10mm Hg.
 Occurs in:
Cardiac tamponade
Constrictive pericarditis
Percardial effusion

33. Anacrotic Pulse
 Slow rising
 Double beating pulse
 Both waves felt in systole
Seen in Aortic Stenosis

35. Dicrotic Pulse
 Twice beating
 First wave in systole, second wave in
diastole
 Seen when PR and DP is low
 Felt due to hypotonia of vessel wall
 Seen in:
Fever (e.g. typhoid fever)
CCF
Cardiac Tamponade

37. RADIO-FEMORAL DELAY
 Most common cause: Coarctation of aorta
 Children:
Upperlimb pulses are usually normal
Reduced volume lowerlimb pulses
 Adults:
Usually presents hypertension and heart failure
 Other causes:
• Atherosclerosis of aorta
• Thrombosis or embolism of aorta

38. OTHER PERIPHERAL
PULSATIONS
 Normal-All pulsations felt equally
Absence of peripheral pulsations:
Peripheral vascular disease
Coarctation of aorta- decreased and delayed
femoral pulsation
Takayasu’s disease: decreased upper limb
pulsation

39. CAUSES OF ABSENT RADIAL
PULSE
 Anatomical abnormality
 Severe atherosclerosis
 Takayasu arteritis (Pulseless disease)
 Embolism in radial artery
 Death

40. ABNORMAL FINDINGS IN
JUGULAR VENOUS PULSE
 Raised in :
Right sided heart failure caused by chronic
pulmonary hypertension in severe lung
disease(COPD)
Cor pulmonale
Increased intrathoracic pressure-tension
pneumothorax or severe acute asthma.
Massive pulmonary embolism- very high JVP

41. Giant ‘a’ wave:Tricuspid valve stenosis
Cannon ‘a’ wave: Complete heart block &
Ventricular tachycardia
Giant ‘v’ wave:Tricuspid Regurgitation
Prominent ‘x’ and ‘y’ descents:
Constrictive pericarditis

43. THANK YOU