The arterial pulse is caused by the transmission of pressure waves along the arteries during ventricular systole. The pulse can be felt over arteries and provides information about heart rate, rhythm, and volume. The jugular venous pulse reflects right atrial pressure and is assessed by observing waves corresponding to atrial contraction and filling. Together, examining the arterial and jugular pulses provides clinical information about cardiovascular function and hemodynamics.

1. ARTERIAL AND VENOUS
PULSE
Dr. ANU PRIYA J

2. Definition: Arterial Pulse
 Rhythmic expansion of the arterial wall due to
transmission of pressure waves that travels along
the arteries due to forceful ejection of blood during
systole into the arterial system
OR
 During each cardiac systole, the aorta experiences a
pressure wave which travels down the arterial tree
that can be felt / palpated

3. Principle
 During each ventricular systole, a
pressure wave is transmitted along the
arterial tree.
 Pressure waves expand the arterial wall
which is palpated as pulse.

4. Instruments
Dudgeons Spyghmograph Student’s physiograph

5. ARTERIAL PULSE

6.  Upstroke, downstroke
 p wave: Percussion /
Tidal: Ejection during
systole
 d wave: Dicrotic wave:
Rebound against closed
aortic valve during
diastole
 n: Dicrotic notch:
closure of aortic valve
ARTERIAL PULSE

7. Procedure
 Forearm is semi-pronated and wrist is
slightly flexed & Gently compress
radial artery against the radius
 Parameters
 Rate
 Rhythm
 Volume (Amplitude)
 Character
 Condition of the vessel wall
 Equality
 Radio-femoral/ Radio-radial delay
 Other peripheral pulses

8. Parameters of the pulse
 Rate: Count 1 complete minute (3 min and avg
for 1 min)
Normal at rest :60-100 beats /min
Rate > 100 : Tachycardia
Rate < 60 : Bradycardia

9. Tachycardia
 Exercise
 Infants, children
 Excitement
 Anxious
 Physiological
 Pathological
 Fever
 Thyrotoxicosis
 Tachyarrythmias
 Hemorrhagic shock

10. BRADYCARDIA
 Athletes
 Old age
 Meditation
 Physiological
 Pathological
 Increased ICT
 Heart blocks

11. Parameters of the pulse
 Rhythm: Spacing order at which
successive pulse waves are felt
 Regular
 Irregular
 Regularly irregular (Atrial fibrillation)
 Irregularly irregular (Premature beats)

12. Parameters of the pulse
 Volume: Degree of expansion of the
vessel wall during each pulse wave.
 Indicates stroke volume,
 High (Magnus) / Low (Parvus)
Pulse pressure is also a measure of the pulse volume

13. VOLUME OF THE PULSE
 Aortic stenosis
 Mitral stenosis
 Pulmonary stenosis
 Shock
 Low volume
 High volume
 Fever
 Thyrotoxicosis
 Exercise

14. Parameters of the pulse
 Character of pulse: Normal: Catacrotic
 Dicrotic: Twice beating, Typhoid
 Pulsus alternans: Alternate strong and weak, LVF
 Pulsus Paradoxus: misnomer, accentuation of normal –
constrictive pericarditis, pericardial effusion

15. Pulsus Bisferiens
In combined aortic stenosis and
regurgitation
Pulse has 2 peaks:
 Upstroke is sharp and rises high to the
first peak
 Falls and rises again to a second peak
A double pulse is felt and seen in the carotid

16. Pulsus alternans
 Alternate high and low volume pulse
 Left ventricular failure

17. Condition of the vessel wall:
 Not palpable /Just
palpable
 Old age
( Locomotor brachii)

18. 3 Finger method
Place 3 middle fingers
on the artery
 Proximal (index)
finger obliterates
 Distal (ring) finger
empties the vessel
(milking)
 Middle finger
palpates, feels the
vessel wall

19. Parameters of the pulse
 Delay in pulse: Normally there is no delay.
 Radio-Radial delay
 Radio-Femoral Delay

20. Parameters of the pulse
Other peripheral pulses:
 Brachial
 Radial
 Femoral
 Popliteal
 Posterior tibial
 Dorsalis pedies
 Carotid
 Temporal

22. How to feel the Carotid Pulse
 Place the left thumb 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.

23. Importance
 Working of the heart
 Circulatory state & hemodynamics
 Condition of the vessel wall
 Mental state
 Body temperature and metabolism

24. REPORT:
 The pulse rate is 80 beats/min ,
regular rhythm, normal volume &
character , vessel wall not palpable,
no Radio-Radial /Radio-femoral delay,
and all the other peripheral pulses are
felt.

25. VENOUS PULSE
 VENOUS PULSE - study the level of
pressure in the internal jugular vein
(jugular venous pressure JVP)
• Significance – internal jugular vein
reflects the pressure changes in the
right atrium.
• External jugular vein is not reliable –
* venous valves, prevents smooth
conduction of venous pressure;
* passes through fascial planes ,
affected by external compression.

27. Normal JVP : 3-4 cm H2O

29. JUGULAR VENOUS PULSE
 WAVES – 3 positive waves a , c, & v
2 negative waves x , & y
 a wave – right atrial contraction , largest
positive wave visible.
 c wave – bulging of closed tricuspid valve into
the right atrium at the beginning of ventricular
systole
 x wave/ x descent – tricuspid valve moves
down as atrial pressure decreases
 v wave – venous filling of blood into right
atrium
 y wave/ y descent – atrial emptying

30. JVP abnormalities
 Absent a – atrial fibrillation
 Cannon / giant a – atria contract
against closed AV valve as in
conduction defects/complete heart
block
 Prominent a – tricuspid stenosis
 Prominent c – tricuspid regurgitation
 Raised JVP – right heart failure

31. Central venous pressure
 Normally, the center of right atrium is 5
cm below the sternal angle. Hence, Add
+5 cm to the above measurement to obtain
the right atrial pressure.
 Central venous pressure/ Right atrial
pressure = JVP+5 cm H20

32. Normal values
 Normal JVP = 0-3 cm H2O
 Normal CVP = 6-8 cm H2O

33. Venous pulse Arterial pulse
Can be seen clearly &
there is an upper limit
Cannot be seen
clearly
Cannot be
felt/palpated
Can be felt/palpated
Upper level falls
during inspiration
No change with
respiration

34. ArterialVenous

35. THANK
YOU

36. GANONG
 ARTERIAL PULSE
Th e blood forced into the aorta during systole not only moves
the blood in the vessels forward but also sets up a pressure
wave that travels along the arteries. Th e pressure wave
expands
the arterial walls as it travels, and the expansion is palpable as
the pulse. Th e rate at which the wave travels, which is
independent
of and much higher than the velocity of blood fl ow, is
about 4 m/s in the aorta, 8 m/s in the large arteries, and 16 m/s
in the small arteries of young adults. Consequently, the pulse
is felt in the radial artery at the wrist about 0.1 s aft er the peak
of systolic ejection into the aorta ( Figure 30–3 ). With advancing
age, the arteries become more rigid, and the pulse wave
moves faster.

37. Th e strength of the pulse is determined by the pulse
pressure and bears little relation to the mean pressure.
Th e pulse is weak (“thready”) in shock. It is strong when
stroke volume is large; for example, during exercise or aft er
the administration of histamine. When the pulse pressure is
high, the pulse waves may be large enough to be felt or even
heard by the individual (palpitation, “pounding heart”). When
the aortic valve is incompetent (aortic insuffi ciency), the pulse
is particularly strong, and the force of systolic ejection may
be suffi cient to make the head nod with each heartbeat. Th e
pulse in aortic insuffi ciency is called a collapsing, Corrigan,
or water-hammer pulse.
Th e dicrotic notch , a small oscillation on the falling phase
of the pulse wave caused by vibrations set up when the aortic

38. valve snaps shut ( Figure 30–3 ), is visible if the pressure
wave
is recorded but is not palpable at the wrist. Th e
pulmonary
artery pressure curve also has a dicrotic notch produced
by the
closure of the pulmonary valves.
ATRIAL PRESSURE CHANGES
& THE JUGULAR PULSE
Atrial pressure rises during atrial systole and continues to
rise during isovolumetric ventricular contraction when the
AV valves bulge into the atria. When the AV valves are
pulled
down by the contracting ventricular muscle, pressure falls
rapidly
and then rises as blood fl ows into the atria until the AV
valves open early in diastole. Th e return of the AV valves

39. reducing atrial capacity. Th e atrial pressure changes are transmitted
to the great veins, producing three characteristic waves
in the record of jugular pressure ( Figure 30–3 ). Th e a wave
is due to atrial systole. As noted above, some blood regurgitates
into the great veins when the atria contract. In addition,
venous infl ow stops, and the resultant rise in venous pressure
contributes to the a wave. Th e c wave is the transmitted
manifestation
of the rise in atrial pressure produced by the bulging
of the tricuspid valve into the atria during isovolumetric
ventricular contraction. Th e v wave mirrors the rise in atrial
pressure before the tricuspid valve opens during diastole.
Th e jugular pulse waves are superimposed on the respiratory
fl uctuations in venous pressure. Venous pressure falls during
inspiration as a result of the increased negative intrathoracic
pressure and rises again during expiration.

40. Guyton
 Arterial Pressure Pulsations
 With each beat of the heart a new surge of blood
fills the arteries. Were it not for distensibility of
the
 arterial system, all of this new blood would have
to flow through the peripheral blood vessels
almost
 instantaneously, only during cardiac systole, and
no flow would occur during diastole. However,
the
 compliance of the arterial tree normally reduces
the pressure pulsations to almost no pulsations
by the
 time the blood reaches the capillaries; therefore,
tissue blood flow is mainly continuous with very
little