3. SKILLS TO PALPATE PULSE
• The pulse is the wave of blood in the artery created by contraction of
the left ventricle during a cardiac cycle (one complete cycle of cardiac
muscle contraction and relaxation).
• Wave is generated by pumping of heart not by flow of blood.
• A normal pulse wave is transmitted peripherally taking 30 msec to
reach the carotids, 60 msec to reach the brachial artery, 80 msec to
reach the radial artery and 75 msec to reach the femoral artery.
4. Pulse is assessed by:
• 1. Rate (No. of beats/min)
• a. Tachycardia
• b. Bradycardia
• 2. Rhythm
• a. Regular
• b. Regularly irregular
• c. Irregularly irregular
• 3. Force, volume, tension
6. • Peripheral pulses are those located in the periphery of the body that
can be felt by palpating an artery over bony prominence or other firm
surface.
• Example of peripheral pulses include the radiaL ,carotid and popliteal
pulses.
7. • The normal pulse appears at regular intervals and has a rate between
60-100 per min.
• There may be a mild variation in the rate between the two phases of
respiration which is called sinus arrhythmia.
8.
9.
10.
11.
12. • On either Side of the lower
neck, below the jaw, fingers
over thyroid cartilage
between the trachea and
medial border of
sternocledomastoid;
• Pressure should not be
applied bilaterally or high on
the neck to avoid stimulation
of the carotid sinus and a
subsequent reflex drop In
pulse rate.
13. • Distal medial aspect of the
humerus, the biceps can be
gently pushed laterally during
palpation, or medially in the
antecubital fossa: elbow should
be slightly flexed and supported
to avoid contraction of biceps.
14. • Inferior to the Inguinal ligament. midway
between the anterior superior iliac spine
and the symphysis pubis: typically monitored
In supine
15. • Inferior aspect of popliteal fossa
popliteal artery is deep and at
times may be difflcult to
palpate;typically monitored In
prone ‘with knee flexed to relax
hamstrings and popliteal fascia
can also be accomplished in
supine
16. • Dorsal, medial aspect of
foot lateral 10 the tendon
of the extensor hallucis
longus: ankle should be
slightly dorsiflexed some
lndividudals have
congenitally nonpalpable
pedal pulses
17.
18. Pulse rythm
• The pulse rhythm is the pattern of pulsations
and the intervals between them.
• In a healthy individual, the rhythm is regular
and indicates that the time intervals between
pulse beats are essentially equal.
• Arrhythmia or dysrhythmia refers to an
irregular rhythm in which pulses are not evenly
spaced.
19. • An irregular rhythm may present as premature, late, or missed pulse
beats, or random, irregular beats in either a predictable or an
unpredictable pattern.
• Irregular rhythms are often associated with conduction abnormalities
or an impulse originating from a site other than the sinoatrial node.
21. • Blood pressure refers to the force the blood
exerts against a vessel wall.
• It is measured in millimeters of mercury (mm
Hg) and recorded in the form of a fraction
(e.g., 119/79).
• The top number indicates systolic pressure,
and the bottom indicates diastolic pressure.
22. • Because liquid flows only from a higher to a lower pressure, the
pressure is highest in the arteries, lower in the capillaries, and lowest
in veins.
• The systolic pressure is the highest pressure exerted by the blood
against the arterial walls. The diastolic pressure (which is constantly
present) is the lowest pressure.
• The mathematical difference between the systolic and diastolic
pressures is called the pulse pressure. For example, a systolic pressure
of 119 mm Hg and a diastolic pressure of 79 mm Hg result in a pulse
pressure of 40 mm Hg.
23. • BP is a function of two primary elements:
• (1) cardiac output (amount of blood flow, CO); and
• (2) peripheral resistance that the heart must overcome.
• The relationship between BP, CO, and R is expressed in the equation:
• BP = CO × R.
24. FACTORS INFLUENCING BLOOD
PRESSURE
BLOOD VOLUME
DIAMETER AND ELASTICITY
OF ARTERIES
CARDIAC OUTPUT
AGE
EXERCISE
VALSALVA MANEUVER
ORTHOSTATIC HYPOTENSION
ARM POSITION
RISK FACTORS
25. BLOOD VOLUME
• The amount of circulating blood in the body directly affects pressure.
• Blood loss (e.g., hemorrhage) will cause pressure to drop and can result in
hypovolemic shock from inadequate tissue perfusion.
• Conversely, an increase in the amount of circulating blood (e.g., blood
transfusion) will cause the pressure to rise.
• Reduced fluid volume, as may occur with diarrhea or inadequate oral
intake (dehydration), will also lower BP; excess fluid, as occurs with CHF,
will increase pressure.
• Essentially, any situation causing a shift (increase or decrease) in body
fluids (intravascular, interstitial, or intracellular) will alter BP. Bladder
distention can also contribute to BP elevation
26. DIAMETER AND ELASTICITY OF ARTERIES
• The diameter (size) of the vessel lumen will provide either increased
peripheral resistance (vasoconstriction) or decreased resistance
(vasodilation) to cardiac output.
• The elasticity of the vessel wall also influences resistance.
• Normally, the expansion and recoil properties of the arterial walls
provide a continuous, smooth flow of blood into the capillaries and
veins between heartbeats.
• With age, these properties are diminished; arterial stiffness decreases
vessel wall compliance. Thus, there is a higher resistance to blood
flow with resultant increase in BP.
27. CARDIAC OUTPUT
• When increased amounts of blood are pumped into the arteries, the
walls of the vessels distend, resulting in a higher BP.
• With lower cardiac output, less blood is pushed into the vessel, and
there is a subsequent drop in pressure.
28. AGE
• BP varies with age. It
normally rises gradually
after birth and reaches a
peak during puberty.
• By late adolescence (18 to
19 years), adult BP is
reached.
29.
30. EXERCISE
• Physical activity increases cardiac output.
• In response to the intensity of the workload, there is a progressive increase
in SBP, no change or a slight increase in DBP, and a widening of pulse
pressure.
• Greater increases are noted in systolic pressure owing to proportional
changes in pressure gradient of peripheral vessels.
• This means that although cardiac output during exercise is high,
vasodilation reduces peripheral resistance to maintain a relatively lower
diastolic pressure.
• A drop in SBP of 10 mm Hg or more with increasing exercise intensity or
failure of SBP to increase with heightened workload is considered an
abnormal response and is indication for stopping exercise.4
31. VALSALVA MANEUVER
• The Valsalva maneuver is an attempt to exhale forcibly with the glottis,
nose, and mouth closed.
• It causes an increase in intrathoracic pressure with an accompanying
collapse of the veins of the chest wall. There is a subsequent decrease in
blood flow to the heart, a decreased venous return, and a drop in BP.
• This maneuver serves to internally stabilize the abdominal and chest wall
during periods of rapid and maximum exertion such as lifting a heavy
object.
• When the breath is released, the intrathoracic pressure decreases, and
venous return is suddenly reestablished as an “overshoot” mechanism to
compensate for the drop in BP. In turn, there is a marked increase in HR
and BP. This rapid rise in arterial pressure causes vagal slowing of the HR
(bradycardia).
32. ORTHOSTATIC HYPOTENSION
• Associated with prolonged immobility and periods of bedrest, orthostatic or
postural hypotension is a sudden drop in BP that occurs when movement to
upright postures (sitting or standing) is initiated.
• The positional change causes gravitational blood pooling in the lower extremity
(LE) veins.
• Venous return and cardiac outputs are reduced
• This can trigger an episode of light-headedness, dizziness, or even loss of
consciousness (syncope).
• In response to positional changes under normal circumstances, BP is maintained
by reflex vasoconstriction (via baroreceptors), which increases HR.
• After a period of inactivity, postural hypotension should be anticipated; it
requires a gradual acclimation to the upright position until normal reflex control
returns.
33. RISK FACTORS
• High BP is also associated with many risk factors, including high
sodium intake, obesity and being overweight, a sedentary lifestyle,
heavy alcohol consumption, pregnancy, sex, and age.
35. • The ankle-brachial index test is a quick, noninvasive way to check for
peripheral artery disease (PAD).
• The disease occurs when narrowed arteries reduce the blood flow to
your limbs.
• PAD can cause leg pain when walking and increases the risk of heart
attack and stroke.
36. • The ankle-brachial index test compares the blood pressure measured
at your ankle with the blood pressure measured at your arm.
• A low ankle-brachial index number can indicate narrowing or
blockage of the arteries in your legs.
37. Procedure
• You likely will be asked to rest for 5 to 30 minutes before the test.
• Typically, you lie on a table on your back, and a technician measures
your blood pressure in both arms and both ankles, using an inflatable
cuff and a hand-held ultrasound device that's pressed on your skin.
The device uses sound waves to produce images and allows your
pulse to be heard in your ankle arteries after the cuff is deflated
38. • No blockage (1.0 to 1.4). An ankle-brachial index number in this
range suggests that you probably don't have PAD. But if you have
symptoms of PAD, your doctor might perform an exercise ankle-
brachial index test.
• Borderline blockage (0.91 to 0.99). An ankle-brachial index number is
this range indicates that you have borderline PAD. Your doctor might
recommend an exercise ankle-brachial index test.
• PAD (less than 0.90). An ankle-brachial index number in this range is
considered abnormal and indicates a diagnosis of PAD. Your doctor
may recommend additional testing, such as ultrasound or
angiography, to view the arteries in your legs.
