A brief description on pulse How to examine and reach the provisional diagnosis

1. EXAMINATION OF PULSE
By
Dr. Md. Razi Ahmad MD(Medicine)
Asist. Prof. GTCH Patna.

2. PULSE ?
Wave form presentation, felt by tip of fingure.
Produce by the cardiac systole, travel in arterial tree
in peripheral direction.
What to assess in a pulse
Rate, Rhythm, Volume, Character
How to assess a pulse
 One/two/three Fingure method
Index fingure or First pore of fingure always inward
direction
Count always full one minute or atleast 30sec x 2

3. Sites of pulse examination

4. Timings of pulse reaching

5. Criteria of Normal Pulse
• Rate:- 60-100beat/minute
• Rhythm:- Regular Sinus
• Volume:- Normal volume pulse assessed by
pulse volume (Systolic-Diastolic) 30-60mmHg
• Character:- Normokinetic which have
percussion and dicortic notch

6. Pulse Rate & its Abnormality
Normal:- 60-100beat/minute
Tachycardia:- >100beat/minute
Bradycardia:- <60beat/minute

7. Causes of Tachycardia
Physiological:- Infants, Children, Emotion,
Exertion etc.
CVS:- Tachyarrhythmia's (SVT, VT, AF etc)
C.F, Cardiogenic Shock, Acute Anterior MI, AV
Fistula, Hypovolemia, Hypotension, etc.
Metabolic:- Thyrotoxicosis,
Pheochromocytoma, Beri-Beri
High Output State:- Anemia, Pyrexia,
Infections etc
Drugs:- Atropine, Pam, Nifedipine, Beta-
agonist, Bronchodilators, Catchecolamines,
Nicotine, Caffeine, etc.
Miscellaneous:-

8. Causes of Bradycardia
Physiological:- Athletes, Deep sleep
Pathological:-
 CVS:- Heart blocks, Sick sinus syndrome,
Inferior wall AMI.
Neurogenic:- Increased ICP/IOP, Narcotic
poison, Brain Tumor.
Metabolic:- Myxoedema, Hypothermia, Severe
Hypoxia, Obstructive Jaundice.
Drugs:- Anti-Arrhythmatic (Beta-blockers,
Dilteazem, Verapamil, Amaderone, Digoxin etc.
Miscellaneous:- Enteric Fever

9. Rhythm of Pulse
Normal:- Regular Sinus
Abnormal Rhythm:-
I. Regularly Irregular:- Atrial
Tachyarrhythmia's, PAT, Atrial Flutter with Fixed
AV block.
II. Irregularly Irregular:- Atrial/Ventricular
ectopics, Atrial Fibrillation, Atrial
Tachyarrhythmia's, Atrial Flutter/Fibrillation with
varying AV block.

10. Pulse Volume
Pulse Volume = Pulse Pressure = Systolic BP -
Diastolic BP (120-80=40)
Normal:- 30-60mmHg
Abnormal:-
I. Hypovolmic Pulse:- Shocks, Sever Infections,
Hemorrhage, Dehydration, Burn, DKA etc.
II. Hypervolmic:- Fluid overload, Hypertension,
Atherosclerosis, Anemia, Thyrotoxicosis, Beri-Beri
etc.

11. Pulse Character

12. Abnormal Pulse Character

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