The Arterial Pulses

Introduction
• The arterial pulse is the rhythmic expansion of pressure waves along
the walls of the arteries which is produced during each systole of
cardiac cycle.
• One of the vital sign that must be checked as it gives information
regarding function of CVS.
• The pulse represents pulse pressure which is the difference between
systolic & diastolic pressure.
• The presence or absence of main peripheral arterial pulses at radial,
brachial, carotid, femoral, popliteal, posterior tibial and dorsalis
pedis arteries should be noted.

Pulse Should Be Checked For:
1- Rate of pulse:-
Number of pulses per minute. Count the pulses rate for not less than
half minute. The pulse rate increases in exercise and decreases in
athletes.
2- Rhythm:-
Regular or irregular. Normal sinus rhythm is regular, but may show
variation in rate beats during respiration. An irregular rhythm usually
indicates atrial fibrillation or ectopic beats.

3- Volume of pulse: -
It is degree of expansion which gives idea about the stroke volume. It
increases in conditions that causes vasodilatation. Physiological causes of
increased pulse volume include exercise, emotion, pregnancy. Examples of
pathological causes of increased pulse volume is aortic regurgitation while
pulse volume decreases in heart failure , peripheral vascular disease and aortic
valve stenosis.
4- The condition of vessel wall:-
In young adult, the wall is not felt while in old people it is like
cord due to atherosclerosis. With advancing age, the arteries
become more rigid. The pulse that is felt in the radial artery at wrist
about 0.1 second after systolic ejection of blood into the aorta and
pulse movement is faster.

Arterial pulse tracing showing in (A) aortic stenosis,
(B) aortic incompetence and (C) pulsus alternans.
5. Character:- Slow rising pulse occurs in aortic stenosis while collapsing pulse
occurs in aortic regurgitation.

Objective:
To examine peripheral arterial pulses.
Materials:
Subjects.
Procedures: The arterial pulses are detected by gently compressing the vessel
against some firm structure usually bones by tip of middle three fingers of
hand. The distal finger is used for empty vessel, the proximal finger is used for
palpate pulse, third middle finger is used for palpate the condition of vessel
wall. Typical pulse in healthy young adult is 70 beats/minute (60 – 100 beats /
minute), regular in rhythm, normal volume, no collapsing and the arterial wall
is just palpable.

Heart Rate Pulse Rate
Definition The rate at which the heart beats, or contracts. Any
contraction (even if it doesn't result in appreciable
blood flow through the arteries) is part of heart
rate.
The temporary increase in arterial pressure that
can be felt throughout the body. Pulse rate can
be used to measure heat rate for a normal,
healthy heart.
Resting Heart Rates Men/Women: 60-100 bpm (beats per minute); pre-
teens and teens (10-20 years old): 60-100 bpm;
children 3-9 years old: 70-130 bpm; infants 1 day
to age 3: 70-190 bpm; athletes may have resting
heartbeat as low as 40 bpm
Men/Women: 60-100 bpm (beats per minute);
pre-teens and teens (10-20 years old): 60-100
bpm; children 3-9 years old: 70-130 bpm;
infants 1 day to age 3: 70-190 bpm; athletes may
have resting heartbeat as low as 40 bpm

Normal Pulse Rates
Babies to age 1: 100–160
Children ages 1 to 10: 60–140
Children age 10+ & Adults: 60–100
Well-conditioned Athletes: 40–60
Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

Arteriolar pulses should be
assessed above and below the
heart.
The following locations are most
commonly assessed.

1- The radial artery pulse
It is best felt when the subject's arm is
pronated and the wrist is slightly flexed. The
three fingers of examiner's hand are used for
feeling the pulse. The index finger is
proximal toward the subject. Slight pressure
is exerted on the radial artery against the
radius by the fingers.

2-The brachial artery pulse:
It is best felt when artery is compressed against
humerus just above the antecubital fossa,
medial to biceps tendon.

3- The carotid artery pulse:-
Pulse is best detected by pressing gently carotid
artery which is placed adjacent to trachea in upper
part of neck, backwards against the front of the
cervical vertebrae. The two carotid pulses should
never be examined together because of danger of
reducing the cerebral arterial supply.

4- The femoral artery pulse:-
It is best detected at halfway between the pubic
tubercle and the anterior superior iliac spine at the
level of the inguinal ligament.

5- The popliteal artery pulse:-
It is best detected by pressing the popliteal
artery in middle of popliteal fossa while the
subject lies on his face, the knee is slightly
flexed

6- Posterior tibial artery pulse:
The posterior tibial artery is
found 1 cm behind the medial
malleolus of the tibia

7-The dorsalis pedis artery pulse
It is best felt by compressed artery against the
tarsal bones at the posterior of foot between
the medial and lateral malleolus.

Superficial Temporal Artery