Pulse

In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck (carotid artery), at the wrist (radial artery), behind the knee (popliteal artery), on the inside of the elbow (brachial artery), and near the ankle joint (posterior tibial artery). The pulse can also be measured by listening to the heart beat directly (auscultation), traditionally using a stethoscope.

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Physiology

The pulse is a decidedly low tech/high yield and antiquated term still useful at the bedside in an age of computational analysis of cardiac performance. Claudius Galen was perhaps the first physiologist to describe the pulse.[1] The pulse is an expedient tactile method of determination of systolic blood pressure to a trained observer. Diastolic blood pressure is non-palpable and unobservable by tactile methods, occurring between heartbeats.

Pressure waves generated by the heart in systole moves the arterial walls. Forward movement of blood occurs when the boundaries are pliable and compliant. These properties form enough to create a palpable pressure wave.

The heart rate may be greater or lesser than the pulse rate depending upon physiologic demand. In this case, the heart rate is determined by auscultation or audible sounds at the heart apex, in which case it is not the pulse. The pulse deficit (difference between heart beats and pulsations at the periphery) is determined by simultaneous palpation at the radial artery and auscultation at the heart apex.

Pulse velocity, pulse deficits and much more physiologic data are readily and simplistically visualized by the use of one or more arterial catheters connected to a transducer and oscilloscope. This invasive technique has been commonly used in intensive care since the 1970s.

The rate of the pulse is observed and measured by tactile or visual means on the outside of an artery and is recorded as beats per minute or BPM.

The pulse may be further indirectly observed under light absorbances of varying wavelengths with assigned and inexpensively reproduced mathematical ratios. Applied capture of variances of light signal from the blood component hemoglobin under oxygenated vs. deoxygenated conditions allows the technology of pulse oximetry.

Normal pulse rates

Normal pulse rates at rest, in beats per minute (BPM):[2]

   newborn (0-30 days old)      infants (1 — 11 months)       children (1 — 10 years)       children over 10 years & adults, including seniors       well-trained adult athletes   
70 - 190 80 - 120 70 - 130 60 - 100 40 - 60

The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardias can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting.[3]

Evaluation

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

The strength of the pulse can also be reported:[4][5]

A collapsing pulse is a sign of hyperdynamic circulation.

Common pulse sites

Upper limb

Chinese medicine has focused on the pulse in the upper limbs for several centuries. The concept of Pulse Diagnosis is essentially a treatise based upon palpation and observations of the radial and ulnar volar pulses at the readily accessible wrist.

Lower limb

Head and neck

Torso

See also

References