Pulse - Evaluation

Evaluation

Several pulse patterns can be of clinical significance. These include:

  • Pulsus alternans: an ominous medical sign that indicates progressive systolic heart failure. To trained fingertips, the examiner notes a pattern of a strong pulse followed by a weak pulse over and over again. This pulse signals a flagging effort of the heart to sustain itself in systole.
  • Pulsus bigeminus: indicates a pair of hoofbeats within each heartbeat. Concurrent auscultation of the heart may reveal a gallop rhythm of the native heartbeat.
  • Pulsus bisferiens: an unusual physical finding typically seen in patients with aortic valve diseases. If the aortic valve does not normally open and close, trained fingertips will observe two pulses to each heartbeat instead of one.
  • Pulsus tardus et parvus: a slower than normal rise in the tactile pulse caused by an increasingly stiff aortic valve. Loss of compliance in the aortic valve makes it progressively harder to open, thus requiring increased generation of blood pressure in the left ventricle.
  • Pulsus paradoxus: a condition in which some heartbeats cannot be detected at the radial artery during the inspiration phase of respiration. It is caused by an exaggerated decrease in blood pressure during this phase, and is diagnostic of a variety of cardiac and respiratory conditions of varying urgency.
  • Tachycardia: an elevated resting heart rate. In general an electrocardiogram (ECG) is required to identify the type of tachycardia.

The strength of the pulse can also be reported:

  • 0 = Absent
  • 1 = Barely palpable
  • 2 = Easily palpable
  • 3 = Full
  • 4 = Aneurysmal or Bounding pulse

A collapsing pulse is a sign of hyperdynamic circulation.

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