Explore a comprehensive guide on Pulse, including pulse rate, factors affecting it, and common abnormalities. Essential reading for understanding pulse in healthcare
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PULSE
The pulse is the alternating expansion (rise) and recoil (fall) of an artery as blood is forced through it during the contraction of the left ventricle. It can be felt at specific points where an artery crosses a bone near the surface of the skin.
When the left ventricle contracts, it pushes approximately 70 ml of blood into the arteries. The elasticity of the artery walls allows them to expand as the blood is forced into them. The arteries then relax as the wave of blood passes, only to expand again with the next heartbeat. This expansion and recoil create the pulse, which is an indication of heart rate frequency.
Common Sites to Feel the Pulse:
- Radial Artery: Located in front of the wrist.
- Temporal Artery: Found over the temporal bone.
- Carotid Artery: Situated at the sides of the neck.
- Brachial Artery: Above the elbow and in the antecubital fossa (inner part of the elbow).
- Femoral Artery: Located in the groin.
- Popliteal Artery: Found in the popliteal fossa (back of the knee).
- Dorsalis Pedis Artery: On the foot.
- Posterior Tibial Artery: Behind the medial malleolus.
Characteristics of the Normal and Abnormal Pulse
Normal Pulse Characteristics:
The normal characteristics of the pulse include the rate (number of beats per minute), rhythm (regularity or equal spacing of the beats), volume (fullness of the artery), and tension (degree of compressibility of an artery).
- Rate: The normal resting adult pulse rate is 60 to 100 beats per minute. A pulse rate over 100 beats per minute is termed tachycardia, while a pulse rate below 60 beats per minute is termed bradycardia.
Table – Normal Pulse Rates by Age:
| Age Group | Normal Pulse Rate (beats per minute) |
|---|---|
| Before Birth (F.H.S) | 140 to 150 |
| At Birth (Newborn) | 130 to 140 |
| First Year | 115 to 130 |
| Second Year | 100 to 115 |
| Third Year | 90 to 100 |
| 4 to 8 Years | 86 to 90 |
| 8 to 15 Years | 80 to 86 |
| Adult | 70 to 80 |
| Old Age | 60 to 70 |
- Rhythm: Rhythm refers to the regularity of the pulse beats. A normal pulse has beats spaced at equal intervals, known as a regular rhythm. An irregular rhythm, where the intervals between beats vary, requires counting the pulse for a full minute.
- Volume: Volume refers to the fullness of the artery felt with each beat. A pulse with a full or large volume indicates a good amount of blood flow, while a weak, thready, or small volume may indicate decreased blood volume, as seen in hemorrhage.
- Tension: Tension refers to the compressibility of the artery. High tension indicates an artery that is difficult to compress, while low tension indicates easy compressibility.
Frequency of Taking Pulse:
The frequency of pulse checks depends on the patient’s condition. For stable patients, pulse is usually checked twice daily, along with temperature. More frequent monitoring is required for patients who are critically ill, post-surgery, or have experienced accidents. The frequency is often determined by a doctor’s orders, such as in cases of hyperthyroidism where the pulse may be recorded during sleep.
Alterations in Pulse
Abnormalities in Rate:
- Tachycardia: Pulse rate over 100 beats per minute.
- Bradycardia: Pulse rate below 60 beats per minute.
Alterations in Rhythm:
- Arrhythmia: Any variation from the normal rhythm, indicating an irregular pulse.
- Dysarrhythmias: Variations in the intervals between beats.
- Intermittent Pulse: Pulse where beats are missed at regular intervals, often indicating a pulse deficit (difference between apical and radial pulse).
- Extrasystoles: Premature cardiac contractions occurring before they are normally due in the cardiac cycle.
- Atrial Fibrillation: Rapid contractions of the atrium causing irregular ventricular contractions in both rhythm and force.
- Ventricular Fibrillation: Rapid twitching of the ventricles, which is fatal.
- Sinus Arrhythmia: Condition where the pulse rate is rapid during inspiration and slow during expiration.
- Dicrotic Pulse: One heart beat with two arterial pulsations, giving the sensation of a double beat.
Volume Alterations:
- Water Hammer Pulse (Corrigan’s Pulse or Collapsing Pulse): A full-volume pulse that rapidly collapses, seen in aortic regurgitation or incompetence.
- Bounding Pulse: Increased stroke volume, as seen in exercise, anxiety, anemia, hepatic failure, heart block, and water hammer pulse.
- Pulsus Alternans: Regular rhythm but alternating strong and weak pulse volumes, seen in left ventricular failure, heart block, and digitalis toxicity.
- Bigeminal Pulse: Accompanied by an intermittent pulse and often seen in hemorrhage, shock, or severe fluid loss (e.g., diarrhea and vomiting).
- Paradoxical Pulse: A pulse that weakens during inspiration and strengthens during expiration, often indicating cardiac damage.
Factors Affecting Pulse
The pulse rate can be influenced by a variety of factors, including age, gender, body build, exercise, food intake, posture, emotional state, application of heat, pain, body temperature, disease conditions, medications, and cold applications. Below is an overview of how these factors impact the pulse rate:
- Age:
- Young individuals: Tend to have a rapid pulse rate.
- Adults: Normal pulse range is 70-80 beats per minute.
- Elderly: Often have a slower pulse rate.
- Gender:
- Females: Generally have a slightly more rapid pulse rate than males.
- Body Build:
- Short, small-built individuals: Typically have a slightly faster pulse rate.
- Tall, heavy individuals: Often have a slower pulse rate.
- Exercise:
- Increased muscular activity: Leads to a higher pulse rate.
- Food Intake:
- After eating: The pulse rate may increase slightly for several hours due to digestion.
- Posture:
- Standing: The pulse rate is higher.
- Sitting or reclining: The pulse rate tends to be lower.
- Emotions/Stress:
- Stress, mental, or emotional disturbances: Temporarily increase the pulse rate.
- Application of Heat:
- Heat: Can lead to an increase in the pulse rate.
- Pain:
- Severe pain: Causes an increased pulse rate.
- Body Temperature:
- Elevated body temperature or fever: Increases the pulse rate due to a higher metabolic rate.
- Disease Conditions:
- Hyperthyroidism, cardiomyopathy, loss of blood, injury, shock: Increase the pulse rate.
- Hypothyroidism: Decreases the pulse rate.
- Heart diseases, infections (e.g., typhoid): Have marked effects on the pulse rate.
- Medications:
- Positive chronotropic drugs (e.g., caffeine, atropine, thyroid hormones, adrenaline): Increase pulse rate.
- Negative chronotropic drugs (e.g., Digitalis – Digoxin, beta-adrenergic blockers, calcium channel blockers): Decrease pulse rate.
- Cold Applications:
- Cold applications: Can reduce the pulse rate.
- Hypothermia: Can lead to a significantly lower pulse rate.
Table: Factors Influencing Pulse Rate
| Factor | Increases Pulse Rate | Decreases Pulse Rate |
|---|---|---|
| Temperature | Fever, Heat | Hypothermia |
| Exercise | Short-term exercise | Long-term exercise: results in lower resting pulse and quicker return to resting level after exercise |
| Emotions | Sympathetic stimulation due to acute pain, anxiety | Parasympathetic stimulation due to unrelieved severe pain, relaxation |
| Medications | Positive chronotropic drugs (e.g., epinephrine) | Negative chronotropic drugs (e.g., Digitalis, beta-adrenergic blockers, calcium channel blockers) |
| Hemorrhage | Sympathetic stimulation due to loss of blood | — |
| Postural Changes | Standing or sitting | Lying down |
| Pulmonary Conditions | Diseases causing poor oxygenation (e.g., asthma, COPD) | — |
These factors are essential considerations in assessing pulse rate as they can significantly impact the results and inform the appropriate care and treatment strategies for patients.