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Cardiac Pulse Abnormalities Guide

This document discusses abnormal findings that can be present in the pulse. It describes abnormalities in rate, rhythm, volume, character, vessel wall condition, and radiofemoral delay. Specific abnormalities are defined such as tachycardia, bradycardia, irregular rhythms, high and low volume pulses, characteristics like collapsing and dicrotic pulses, and causes of delays between upper and lower limb pulses. Causes and mechanisms are provided for each abnormal finding.

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Angelo Laciste
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225 views43 pages

Cardiac Pulse Abnormalities Guide

This document discusses abnormal findings that can be present in the pulse. It describes abnormalities in rate, rhythm, volume, character, vessel wall condition, and radiofemoral delay. Specific abnormalities are defined such as tachycardia, bradycardia, irregular rhythms, high and low volume pulses, characteristics like collapsing and dicrotic pulses, and causes of delays between upper and lower limb pulses. Causes and mechanisms are provided for each abnormal finding.

Uploaded by

Angelo Laciste
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ABNORMAL FINDINGS IN

PULSE
Abnormality can be in the:
 Rate
 Rhythm
 Volume
 Character
 Condition of vessel wall
 Radiofemoral delay
ABNORMAL FINDINGS IN
PULSE RATE
1.Tachycardia(Pulse Rate>100 bpm)

2.Bradycardia(Pulse Rate<60 bpm)


TACHYCARDIA
Sinus rhythm Arrhythmia
Exercise Atrial Fibrillation
Infants Atrial flutter
Excitement/Anxiety Ventricular Tachycardia
Pheochromocytoma
Fever
Hyperthyroidism
MEDICATION:
Ca channel blockers(Nifedipine)
Sympathomimetics(e.g. salbutamol)
Vasodilators
BRADYCARDIA
Sinus rhythm Arrhythmia

Sleep Carotid Sinus hypersensitivity

Athletic training Sick Sinus Syndrome

Hypothyroidism Second-Degree heart block

MEDICATION: Complete heart block

Beta-blockers

Digoxin

Verapamil, Diltiazem
ABNORMAL FINDINGS IN RHYTHM
If Irregular:
 Occasionally irregular
 Regularly Irregular
 Irregularly Irregular
CAUSES OF AN IRREGULAR PULSE
Occassionally Irregular Pulse
• Extrasystole
Regularly Irregular Pulse
• Ectopic beat occuring at a regular interval
• Second degree atrioventricular block
• Sinus arrhythmia
Irregularly Irregular Pulse
• Atrial Fibrillation
• Multiple ectopics
PULSE APEX DEFICIT
 Difference in heart rate and
pulse rate
Atrial Fibrillation (>10/min)
Multiple ectopics (<10/min)
ABNORMALITIES IN PULSE VOLUME
High Volume Pulse
Low Volume Pulse
Varying Volume
High Volume Pulse
Physiological causes:
Exercise
Pregnancy
Advanced Age
Increased Environmental
Temperature
Pathological causes
• Arteriosclerosis
• Aortic regurgitation
• PDA
• Arteriovenous fistula
• Fever
• Thyrotoxicosis
• Anaemia
• Beri-Beri
• Complete heart block
• Cirrhosis liver
Low Volume Pulse
Causes:
 Left Ventricular Failure
 Hypovolemia
 Peripheral arterial disease
 Shock
 Severe Aortic Stenosis
 Pericardial Effusion
Varying Volume
 Combination of low, normal or high
volume pulse in varying manner

 Seen in:
Atrial fibrillation
Ventricular Tachycardia
CONDITION OF VESSEL WALL
Can be:

Normal-Soft

Thickened-firm to hard and cord-like


Elderly due to artherosclerosis
CHARACTER OF PULSE
 Collapsing pulse
 Slow rising pulse
 Pulsus bisferiens
 Pulsus parvus et tardus
 Pulsus bigeminus
 Pulsus alternans
 Pulsus paradoxus
 Anacrotic pulse
 Dicrotic pulse
Collapsing pulse/Water-hammer
pulse/Corrigan’s pulse
Collapsing pulse
 Sharp rise
 Ill-sustained
 Sharp fall
 Wide pulse pressure(>80mmHg)
 High volume collapsing pulse in:
Aortic regurgitation
PDA
 Normal volume collapsing pulse in:
Mitral Regurgitation
Mechanism
 In aortic regurgitation, during diastole:

Left ventricle receives

normal pulmonary venous return+portion of blood

ejected into the aorta => large stroke volume-

vigorously ejected=> rapidly rising carotid pulse


Collapses in early diastole – backflow through

aortic valve

Exaggerated at the radial artery by liftng the

arm.
Slow Rising Pulse
 Gradual upstroke with a reduced peak
 Occur late in systole
 Seen in severe aortic stenosis
Mechanism
Fixed obstruction restricts the rate at which

blood can be ejected from the left ventricle.


Pulsus Bisferiens
 Increased pulse with double systolic peak
seperated by a distinct mid-systolic dip.
 Causes:
Aortic regurgitation
Concomitant aortic stenois and regurgitation
Pulsus Parvus et Tardus
 Weak and delayed pulse

 Seen in conditions with:


 diminished left ventricular stroke volume
Narrow pulse pressure
Increased peripheral vascular resistance

 Aortic stenosis
Pulsus bigeminus
 Regular alteration of pulse pressure
amplitude.

 Caused by premature ventricular


contraction that follows each regular beat

 Occurs in:
AV block
Sinoatrial block with Ventricular Escape
Pulsus alternans
 Beat-to-beat variation in pulse volume with a
normal rhythm.

 Rare

 Occurs in :
Advanced heart failure
Toxic myocarditis
Paroxysmal Tachycardias
Following Premature beat
Pulsus Paradoxus
 Exaggeration of the normal variability of
pulse volume with breathing.

 Inspiratory decline in systolic pressure


greater than 10mm Hg.

 Occurs in:
Cardiac tamponade
Constrictive pericarditis
Percardial effusion
Anacrotic Pulse
 Slow rising

 Double beating pulse

 Both waves felt in systole

 Seen in Aortic Stenosis


Dicrotic Pulse
 Twice beating
 First wave in systole, second wave in
diastole
 Seen when PR and DP is low
 Felt due to hypotonia of vessel wall
 Seen in:
Fever (e.g. typhoid fever)
CCF
Cardiac Tamponade
RADIO-FEMORAL DELAY
 Most common cause: Coarctation of aorta
 Children:
Upperlimb pulses are usually normal
Reduced volume lowerlimb pulses
 Adults:
Usually presents hypertension and heart failure
 Other causes:
• Atherosclerosis of aorta
• Thrombosis or embolism of aorta
OTHER PERIPHERAL
PULSATIONS

 Normal-All pulsations felt equally

 Absence of peripheral pulsations:


Peripheral vascular disease
Coarctation of aorta- decreased and delayed
femoral pulsation
Takayasu’s disease: decreased upper limb
pulsation
CAUSES OF ABSENT RADIAL
PULSE
 Anatomical abnormality

 Severe atherosclerosis

 Takayasu arteritis (Pulseless disease)

 Embolism in radial artery

 Death
ABNORMAL FINDINGS IN
JUGULAR VENOUS PULSE
 Raised in :
Right sided heart failure caused by chronic
pulmonary hypertension in severe lung
disease(COPD)
Cor pulmonale
Increased intrathoracic pressure-tension
pneumothorax or severe acute asthma.
Massive pulmonary embolism- very high JVP
Giant ‘a’ wave: Tricuspid valve stenosis

Cannon ‘a’ wave: Complete heart block &


Ventricular tachycardia

Giant ‘v’ wave: Tricuspid Regurgitation

Prominent ‘x’ and ‘y’ descents:


Constrictive pericarditis
THANK YOU

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