The document discusses pulse examination. It defines pulse as a wave generated at the aorta and spreading along arterial walls due to heart pumping blood. Pulse is examined at superficial arteries like the radial artery. It is examined using three fingers to check rate, rhythm, volume, force, tension and equality on both sides. The condition of the vessel wall and peripheral pulsations are also examined. Apex pulse ratio can indicate cardiac arrhythmias if the heart rate and pulse rate are not equal.

1. Pulse
Examination
1

2. 2
What is
Pulse ?
• Pulse is a wave generated at the base of
Aorta & spreading along the arterial wall
to the peripheral arteries
• Wave is generated due to pumping of
blood by heart
• Pulse is not due to blood flow under the
vessel

3. 3
Pulse
Examination
• Pulse is examined at superficial arteries
• Most common site is Radial Artery
• It can be compressed against the bone
,that is why it is commonly selected

4. 4
Pulse
Examination
• Done with 3 fingers – Index ,Middle & Ring
• Index finger should be kept proximal to heart &
Ring finger should be distal from heart
• Proximal finger will check the force of pulse
• Purpose of distal finger is to obliterate the back
flow coming from Ulnar artery .Light pressure is
given by ring finger to obliterate
• Rest all parameters of pulse are judged
by middle finger

5. 5
Clinical Examination of
Pulse
• 1) Rate
• 2) Rhythm
• 3) Volume
• 4) Force
• 5) Tension
• 6) Equality on both
sides
• 7) Condition of vessel
wall
• 8) Peripheral Pulsations

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1)
Rate
• Count Pulsations with watch for full 1
minute
• Minimum 3 readings are essential
• When consecutive 2 readings are same
,that is correct pulse
• Tachycardia & Bradycardia can be
diagnosed

7. Counting pulse rate in full one
minute
7

8. 8
2)
Rhythm
• Whether beats are coming at regular
interval ?
•
• In healthy individual ,we get
regular or rhythmic pulse
• Irrgular pulse is obtained in Cardiac
Arrythmias

9. 9
2)
Rhythm
• Rarely in children ,we get regularly
irregular pulse .This is called as Sinus
Arrythmia
• During Inspiration ,pulse rate
increases & during expiration ,pulse
rate decreases
• As age increases ,Vagal tone improves &
Sinus Arrythmia goes away

10. 10
3)
Volume
• Uplift to middle finger
• It denotes Pulse Pressure
•
• Pulse Pressure = SBP – DBP
• If patient has high Systolic & low
Diastolic BP
,then Pulse pressure is more
.Therefore Volume will be more

11. Middle
Finger
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12. Uplift to middle
finger
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13. 13
4)
Force
• Put pressure on Index finger ,to
obliterate the blood flow & stop
pulsations
• The amount of pressure required to be
applied to obliterate or stop the blood flow
indicates Force of pulse
• It gives rough idea of Systolic Blood
Pressure

14. Pressure by Index
finger to
Obliterate flow
14

15. 15
5)
Tension
• Feel of the Pulse ,between 2 uplifts
• It gives rough idea about Diastolic
Blood Pressure

16. 16
6) Equality of
Pulse
• Pulse of right & left side , should be
examined simultaneously
• Normally pulsations on both sides are
felt at one & the same time

17. Pulse equality on both
sides
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7) Condition of vessel
wall
• Roll artery under the fingers
• Normally it is elastic
• In old age ,due to atherosclerosis ,it
gives wire or cord like feeling

19. Rolling of
fingers
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8) Pulse examination at other places
• 1) Superficial Temporal Artery
• 2) Facial Artery ( Anterior border of
Masseter muscle)
• 3) Carotid Artery ( Medial to
Sternocleido mastoid muscle)
• 4) Brachial Artery ( Medial to Bicep
Tendon)

21. Temporal
artery
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22. Facial
Artery
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23. Carotid
artery
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24. Brachial
Artery
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8) Pulse examination at other places
• 5) Femoral Artery ( Inguinal region)
• 6) Popliteal Artery ( Behind knees)
• 7) Dorsalis Pedis Artery ( 1st Intertarsal
space)
• This examination is IMP to diagnose
Peripheral vascular diseases like TAO (
Thrombo Agitans Obliterans)

26. Popliteal
Artery
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27. Dorsalis pedis
artery
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9) Apex Pulse
ratio
• Corelate beating of heart with pulse
• One hand is put on pulse & 2nd hand is
put on heart ,at Apex beat
• Apex beat will be felt first ,followed by
pulse beat
• One to one relation indicates HR = PR
• If HR > PR – This is Pulsus Deficit
,indicating Cardiac Arrythmias

29. 9) Apex Pulse
ratio
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Sphymogra
ph
• Examination of pulse = Mirror of heart
• Pulse can be recorded in a Graph ,with
computerized instrument ,called as
Sphymograph
• It will show positive wave or Anacrotic wave
,indicating Ventricular systole
• Down stroke is called as Catacrotic wave
,indicating Ventricular Diastole
• There is Dicrotic notch between 2 waves
,Dicrotic notch ,due to closure of Aortic
semilunar valves

31. Pulse wave
tracing
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Sphymogra
ph
• Whatever wediagnose by clinical
pulse examination can be
diagnosed by Sphygmograph
• Ayurvedic diagnosis of Vata ,Pitta ,Kapha
Nadi
can be objectively compared by
Sphymograph

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Please see also
Videos
• Copy ,Paste Link as URL
• Pulse Examination
--
By
Prof.Dr.R.R.deshpand
e
• https://youtu.be/mATZjnD9b
F8

34. Prof.Dr.R.R.Deshpa
nde • Sharing of
Knowledge
• FOR
• Propagating
Ayurved
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