Radial pulse

Significance of radial pulse:
The pulse is meant the expansion and elongation of the arterial walls passively produced by the pressure changes during systole and diastole of ventricles.
The arterial pulse is conveniently assessed by palpation of the radial artery.

Related terms:

1. Pulse pressure: It is the pressure wave created by the ventricles while ejection of blood in to the fully distended aorta and propagated as a wave through the blood column towards periphery.
2. Velocity of pulse wave: the velocity of pulse wave is much more rapid(6 times) than the velocity of blood flow. Pulse velocity depends on the elasticity of vessels.Thus, elasticity = 1.7/pulse velocity
3. Elasticity of walls: elasticity decreases with age, so that in older people same cardiac output causes a high systolic pressure.Therefore, elasticity decreases, velocity increases.

Features of radial pulse:
While examining the radial pulse following features are to be noticed.

Rate: The normal adult has a pulse rate of about 72 beats each minute. Infants have higher average pulse rates. The normal pulse rate ranges based upon age are given below.

• Adults: 60 to 100 beats per minute.
• Children: 70 to 120 beats per minute.
• Toddlers: 90 to 150 beats per minute.
• Newborns: 120 to 160 beats per minute.

Pulse rates that are outside the normal range are classified as tachycardia or bradycardia.

• Tachycardia: If the patient's pulse rate is over 100 beats per minute.
• Bradycardia: If the patient's pulse rate is below 50 beats per minute.

Rhythm: Rhythm refers to the evenness of the beats. In a regular pulse, the time between beats is the same (constant) and the beats are of the same Strength
Volume:
Tension:

Varieties of radial pulse:
The normal pulse appears at regular interval and has a rate between 60-100/minutes.
Anacrotic pulse: It is a slow rising twice beating pulse where both the waves are felt during systole.
Dicrotic pulse: It is a twice beating pulse where the first percussion wave is felt during systole and the second dicrotic wave is felt during diastole.
It is seen when the peripheral resistance and diastolic pressure are low as in;

• Fever
• Congestive cardiac failure
• Cadiac temponade

Pulsus bisferiens: It is a rapid rising twice beating pulse where both the waves are felt during systole.
It is seen in;

• Idiopathic hypertrophic subaortic stenosis.
• Severe AI with AS.

Pulsus parnus: It is a slow rising pulse like the anacrotic pulse but the anacrotic wave is not felt.
It occurs in;

• Cardiac failure
• Hypovolaemia
• Vasoconstriction

Pulsus alternans: It describes an alternating pattern of large and small volume beats despite a regular rhythm.
It occurs in;

• LVF
• Toxic myocarditis.

Pulsus paradoxus:
Pulsus bigeminus:
Thready pulse:
Water hammer pulse:
Sinus arrhythmia:
Atrial fibrillation:
Ectopic beats:
Technique of examining radial pulse: