2. Object : Clinical examination of Radial Pulse
Definition : The rhythmic expansion and recoil of the arterial wall, due to
transmission of pressure along the wall of arteries, that are produced
during each systole of heart, is known as PULSE or the ARTERIAL
PULSE.
3. Importance of pulse examination
Examination of radial pulse provide physiological information regarding:
1. Working of the heart
2. Circulatory state, blood pressure and blood volume
3. Condition of the blood vessels
4. State of the autonomic activity in the body at that movement
5. Mental state of the subject
6. State of body metabolism and temperature
4. Examination of arterial pulse includes peripheral arteries like:
Radial artery
• Femoral artery
• Popliteal artery
• Posterior tibial artery
• Dorsalis pedis artery
Among these routinely, pulse examination is done over Radial
Artery, because:
1. It is easily accessible and located over exposed parts of body.
2. The radial artery lies over the hard surface of the lower end
of radius.
5. PROCEDURE:
• Radial pulse is examined by compressing the radial artery against the
head of radius.
• The subject forearm is slightly pronated and wrist slightly flexed.
• Radial artery is palpated with the tip of 3 fingers:
1. Index finger ( towards heart ) – varies the pressure on the artery.
2. Middle finger – feels the pulse.
3. Distal finger – prevents reflections of pulsations from the palmar
arch of arteries.
6. Following observations are made:
1. Rate of pulse
2. Rhythm
3. Character or wave form
4. Volume
5. Condition of vessel wall
6. Equality on both sides
7. 1. Rate Of Pulse
expressed as beats per minute
• In a healthy subject, it indicates the true rate of ventricular systole
• Count the beats for full one minute.
• Normal pulse rate range, at rest : 80 ± 20 per minute (avg 72 per min).
• Normal Pulse rate is more in children : 90 -110 per min.
• Normal Pulse rate is less in older : 55 - 65 per min.
• Tachycardia : increase in pulse rate ( >100 per min. )
Causes of tachycardia-
Physiological: pregnancy , exercise , anxiety.
Pathological: fever, thyrotoxicosis, arrythmias, shock, anaemia.
• Bradycardia : decrease in pulse rate ( < 60 per min. )
Causes of bradycardia Physiological: deep sleep , old age , trained persons.
Pathological: typhoid fever, hypothyroid, complete heart block.
8. 2. RHYTHM
• In a normal healthy person, pulse rate is REGULAR.
• However, pulse rate increase during deep inspiration and decrease during deep
expiration.
• When this happens during quiet breathing, its known as SINUS
ARRYTHMIA, which is due to radiation of impulses from inspiratory center
to the cardiac inhibitory center.
• The rhythm may become irregular either regularly irregular or irregularly
irregular due to initiation of ectopic beats, atrial flutter or fibrillation, and
various degrees of heart block.
9. 3. Character Or Wave Form
• For recording the contours (i.e. character) of the pulse, sphygmograph
is used.
• For this, right carotid artery is palpated as it is closest to the heart and
least subjected to distortion.
10. • The Normal Pulse Wave Shows Following Components:
1. P : percussion wave
it is due to ventricular systole.
2. t : tidal wave (= Predicrotic wave)
it is due to elasticity of aorta.
3. n : aortic notch
a negative wave due to regurgitation of blood towards the left
ventricle from aorta at the beginning of diastole.
4. d : dicrotic wave
it is due to return of the same blood volume being reflected back by
closed semilunar valves.
11. Types of Abnormal pulse waves:
1. Anacrotic pulse = means 2 upbeats.
• Seen in aortic stenosis
• Small volume pulse with slow rising peak.
• Due to slow ejection of blood from left ventricle.
2. Water hammer or collapsing pulse.
• Rapid upstroke and rapid descent.
• Due to regurgitation of blood from aorta back into the left ventricle or
abnormal leak from the arterial system.
• Seen in AR (aortic valve incompetence) or PDA ( patent ductus arteriosus).
12. 3. Bisferiens pulse
Combination of 1st and 2nd wave forms i.E. Slow rising and collapsing pulses.
4. Pulses paradoxus
Pulse becomes smaller or even disappears at the end of deep inspiration.
It is called paradoxus because heart sounds may still be heard on auscultation over
precordium at at time where no pulse is palpable at the radial artery.
Seen in large pericardial effusion ( also known as cardiac tamponade).
Or in constrictive pericarditis.
5. Pulses alternans
Alternate large and small beats.
Seen in myocardial infarction when left ventricle is severely damaged.
13. 4. VOLUME
• The volume of pulse refers to the amplitude of the movement of the artery during the
passage of pulse wave.
• It is a measurement of :
• (i) amount of the blood flowing with every beat.
• (ii) pulse pressure.
• cause of Low volume pulse :
• (i) thin, thready pulse due to decrease in stroke volume as in acute shock.
14. 5. Condition of the vessel wall
• Normally the arterial wall is not palpable.
• In the old age, it is well palpable as a cord-like structure, as due to arteriosclerosis and
calcification the vessel may become tortous.
6. Equality On The Two Sides
The arterial pulse of one side is always compared with that of the other side for all its
features.
• Normally, there is no difference.
15. PRECAUTIONS
• The arm should be properly positioned.
• Count the pulse for full one minute.
• The subject should relax and rest for a minimum of 5 min.
• Pulse of both sides should be examined and compared.
