Arterial Pulse – Characteristics
The arterial pulse is a pressure wave transmitted through the arterial system following each heartbeat. It is assessed at superficial arteries, most commonly the radial artery, but also at the carotid, brachial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries. The normal pulse is regular, has a rate of 60–100 bpm, and moderate volume.
Key features to assess during pulse examination:
- Rate: Count beats per minute.
- Rhythm: Regularity of the pulse. Irregular rhythm may indicate arrhythmia (e.g., atrial fibrillation).
- Volume (Amplitude): Reflects stroke volume and peripheral resistance.
- Character (Contour): Shape of the pulse wave. Slow rising pulse suggests aortic stenosis; collapsing pulse suggests aortic regurgitation.
- Symmetry: Compare pulses bilaterally.
- Vessel Wall Condition: Thickening or calcification may be felt in peripheral artery disease.
Examination Steps for Arterial Pulses
- 1. Radial Pulse:
- Palpated on the lateral aspect of the wrist using the index and middle fingers.
- Evaluate rate, rhythm, volume, and vessel wall.
- Compare both sides for symmetry.
- 2. Carotid Pulse:
- Palpated medial to the sternocleidomastoid muscle at the level of the thyroid cartilage.
- Always palpate one side at a time to avoid compromising cerebral perfusion.
- Useful for assessing the character of the pulse (e.g., anacrotic or collapsing).
- 3. Femoral Pulse:
- Located below the inguinal ligament, midway between the pubic symphysis and anterior superior iliac spine.
- Absence or delay compared to radial may suggest aortic coarctation.
- 4. Popliteal Pulse:
- With the knee flexed and the patient lying supine, press deeply into the popliteal fossa.
- Often difficult to feel even in normal individuals.
- 5. Dorsalis Pedis and Posterior Tibial Pulses:
- Dorsalis pedis: on the dorsum of the foot, lateral to extensor hallucis longus tendon.
- Posterior tibial: posterior to the medial malleolus.
- Important in assessing peripheral arterial disease (PAD).