Arterial Pulse

Aka: Arterial Pulse, Pulse, Abnormal Arterial Pulsation, Abnormal Pulse, Water-Hammer Pulse, Water Hammer Pulse, Abrupt Pulse, Pulsus parvus et tardus, Pulsus Alternans, Pulsus Bisferiens, Double Pulse, Asymmetric Pulse

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II. Exam: Locations

  1. Peripheral arterial pulsation
    1. Arm
      1. Radial pulse (wrist)
      2. Ulnar pulse (wrist)
      3. Brachial pulse (antecubital)
    2. Foot
      1. Posterior tibial pulse
      2. Dorsalis pedis pulse
  2. Central arterial pulsation
    1. Carotid pulse (Neck)
    2. Femoral pulse (Groin)

III. Exam: Pulse loss in Hypotension

  1. In Hypotension, radial pulse is lost first, then femoral and then carotid
    1. Systolic Blood Pressure at which each Blood Pressure is lost is variable per patient
    2. Old ATLS guidelines (see below) appeared to overestimate the systolic Blood Pressure at which pulse was lost by at least 10 mmHg
  2. Old ATLS estimates - deprecated from current ATLS guidelines (cutoff was overestimated by at least 10 mmHg)
    1. Radial pulse present if systolic Blood Pressure >80 mmHg
    2. Femoral pulse present if systolic Blood Pressure >70 mmHg
    3. Carotid pulse present if systolic Blood Pressure >60 mmHg
  3. References
    1. Deakin (2000) BMJ 16:321(7262): 673-4 [PubMed]

IV. Findings: Abnormal

  1. See Arrhythmia for abnormal rate or rhythm
  2. Water-Hammer Pulse: Large amplitude, rapidly rising (Abrupt Pulse)
    1. Hypertrophic Cardiomyopathy
    2. Aortic Regurgitation
    3. Mitral Regurgitation (severe)
    4. Patent Ductus Arteriosus
  3. Pulsus parvus et tardus (Small amplitude, slow rising)
    1. Definitions
      1. Parvus: Low volume pulse
      2. Tardus: Slow rate of rise to carotid or brachial pulse - nudge instead of a strong tap
    2. Causes
      1. Aortic Stenosis
      2. Diminished Cardiac Output
  4. Pulsus Alternans (alternating strong and weak pulse)
    1. Left Ventricular Systolic Dysfunction
  5. Pulsus Paradoxus (Diminished pulse on inspiration)
    1. Cardiac Tamponade
    2. Congestive Heart Failure (severe)
    3. Chronic Obstructive Pulmonary Disease (severe)
    4. Asthma
    5. Constrictive Pericarditis
  6. Pulsus Bisferiens (Double-peak pulse)
    1. Aortic Regurgitation
    2. Hypertrophic Cardiomyopathy
  7. Asymmetric Pulse
    1. Central Causes
      1. Aortic Dissection
      2. Aortic Coarctation
      3. Subclavian Steal Syndrome
      4. Takayasu Arteritis
    2. Peripheral Causes
      1. Peripheral Arterial Disease (to the point of Critical Limb Ischemia)
      2. Compartment Syndrome (or other acute peripheral vascular compromise)
  8. References
    1. Chizner (2002) Dis Mon 48:7-98 [PubMed]
    2. Giese (2007) Am Fam Physician 75:1008-14 [PubMed]

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