ivifvifff

1. ‫ة‬‫ب‬‫ود‬‫ع‬‫س‬‫ال‬‫ة‬‫ي‬‫ب‬
‫ر‬‫ع‬‫ال‬‫ة‬‫ك‬‫ل‬‫م‬‫م‬‫ل‬‫ا‬
‫م‬‫ي‬‫ل‬‫ع‬‫ت‬‫ال‬
‫ازة‬‫وز‬
‫ان‬‫ر‬‫ج‬‫ن‬‫ة‬‫ع‬‫م‬‫ا‬‫ج‬
‫ة‬‫ل‬‫ا‬‫ك‬‫و‬‫ال‬‫م‬‫س‬‫ا‬
/
‫ة‬‫ي‬‫ل‬‫ك‬‫ال‬
/
‫ادة‬‫م‬‫ع‬‫ال‬
‫داد‬‫ع‬‫ا‬
‫ي‬‫ث‬‫ا‬‫ل‬‫ث‬‫ال‬‫م‬‫س‬‫لا‬‫ا‬
‫ة‬‫ي‬‫م‬‫ل‬‫ع‬‫ال‬
‫ة‬‫ج‬‫دز‬‫ال‬
The Arterial Pulse
‫ام‬‫ع‬‫ال‬
1444-2023

2. The Arterial Pulse
• With each contraction ,the left ventricle ejects a volume of
blood into the aorta and on into the arterial tree
• A pressure wave moves rapidly through the arterial system
where it can be felt as the arterial pulse

4. • Ascending limb
• Caused by ejection of blood from ventricle during systole
•Descending limb
• Escape of blood to peripheral circulation during diastole

5. Dicrotic notch
• Trial of blood to return back to Lt ventricle causes lowering of
pressure
• Then pressure elevated again due to closure of the aortic
valve and also elastic recoil of aorta

6. • The arterial pulse should be examined in all 4 limbs
and both sides of the neck
1. Radials
2. Brachials
3. Carotids
4. Femorals
5. Popliteals
6. Peripheral arteries of the legs :
• Dorsalis pedis
• Posterior tibial

7. How to feel the Pulse
• The Radial pulse:
• The 3 middle fingers are used
• The palmar surface of the fingers overlies the radial A. and encircles
the wrist
• At first the artery is completely occluded, then gradually release the
pressure until maximum feeling of the pulse wave is perceived.

8. The Carotids
• The patient lies down with the head of the bed elevated 30
degrees
• Carotid pulsations may be visible just medial to sternomastoid
• Place the left index on the right carotid A. in the lower third of
the neck at the level of the cricoid cartilage, just inside the
medial border of the sternomastoid and press posteriorly
• Never press both carotids at same time

9. Brachial Artery
• Rest the patient arm with elbow extended palm up
• Use the thumb of the opposite hand
• Cup your hand under the patient elbow
• Feel the pulse just medial to biceps tendon

10. Femoral Pulse
• Press deeply below the inguinal ligament and about mid way
between ASIS and SP

11. Popliteal Pulse
• Patient knee should be flexed –leg relaxed
• Place the finger tips of both hands so that they meet in the
middle line behind the knee and press them deeply in the
popliteal fossa

12. Dorsalis Pedis
• Feel the dorsum of the foot just lateral
to the extensor tendon of the big toe
• If you cannot feel the pulse, explore the
dorsum of the foot more laterally

13. Posterior Tibial
• Curve your fingers behind and slightly below the medial
malleolus of the ankle

14. Comment on the Pulse
• Rate
• Rhythm
• Volume (amplitude)
• Comparison of the two sides
• Special character
• Condition of the arterial wall

15. Rate
• Rate of the pulse at radial artery
• Normal at rest :60-90 beat / min
• if regular: count in 15 sec x 4
• if fast (tachycardia ) or slow (bradycardia)
• if irregular count in 1 min

16. Rhythm
• Is the rhythm regular or irregular?
• If irregular:
• Totally irregular (atrial fibrillation)
• Irregular beats in a basically regular rhythm (premature beats)

17. Types of Pulses

18. Water hammer pulse
• Rapid upstroke
• Rapid down stroke
• High amplitude
• Short duration
• Found in :
1. Aortic incompetence
2. Fever
3. Anaemia
4. Thyrotoxicosis

19. Water hammer pulse (collapsing / Corrigan's pulse):
Sudden drop from a high systolic pressure to a very low diastolic pressure
(high pulse pressure) & occurs in hyperdynamic circulation.

20. • Pulse curve of lower amplitude & occurs in Aortic stenosis.
Flat or Plateau pulse
(pulsus parvus et tardus):

21. Pulsus alternans:
Alternating strong and weak pulse & occurs in ischemic heart
diseases and heart failure.

22. Pulsus deficit:
• Pulse rate is less than heart rate & occurs in atrial fibrillation
.

23. •Pulsus bigeminus:
• In ventricular extra systole and in digitalis toxicity

24. Absent pulse in:
• Adams Stock Attack,
• Complete Arterial Obstruction,
• Ventricular Fibrillation