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Pulse- Abnormal Findings

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Examination of pulse
Examination of pulse
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Pulse- Abnormal Findings

  1. 1. ABNORMAL FINDINGS IN PULSE Abnormality can be in the:  Rate  Rhythm  Volume  Character  Condition of vessel wall  Radiofemoral delay
  2. 2. ABNORMAL FINDINGS IN PULSE RATE 1.Tachycardia(Pulse Rate>100 bpm) 2.Bradycardia(Pulse Rate<60 bpm)
  3. 3. TACHYCARDIA Sinus rhythm Arrhythmia Exercise Atrial Fibrillation Infants Atrial flutter Excitement/Anxiety VentricularTachycardia Pheochromocytoma Fever Hyperthyroidism MEDICATION: Ca channel blockers(Nifedipine) Sympathomimetics(e.g. salbutamol) Vasodilators
  4. 4. 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
  5. 5. ABNORMAL FINDINGS IN RHYTHM If Irregular: Occasionally irregular Regularly Irregular Irregularly Irregular
  6. 6. 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
  7. 7. PULSE APEX DEFICIT Difference in heart rate and pulse rate Atrial Fibrillation (>10/min) Multiple ectopics (<10/min)
  8. 8. ABNORMALITIES IN PULSE VOLUME HighVolume Pulse LowVolume Pulse VaryingVolume
  9. 9. High Volume Pulse Physiological causes: Exercise Pregnancy Advanced Age Increased Environmental Temperature
  10. 10. Pathological causes • Arteriosclerosis • Aortic regurgitation • PDA • Arteriovenous fistula • Fever • Thyrotoxicosis • Anaemia • Beri-Beri • Complete heart block • Cirrhosis liver
  11. 11. Low Volume Pulse Causes:  LeftVentricular Failure  Hypovolemia  Peripheral arterial disease  Shock  Severe Aortic Stenosis  Pericardial Effusion
  12. 12. Varying Volume  Combination of low, normal or high volume pulse in varying manner  Seen in: Atrial fibrillation VentricularTachycardia
  13. 13. CONDITION OF VESSEL WALL Can be: Normal-Soft Thickened-firm to hard and cord-like Elderly due to artherosclerosis
  14. 14. CHARACTER OF PULSE  Collapsing pulse  Slow rising pulse  Pulsus bisferiens  Pulsus parvus et tardus  Pulsus bigeminus  Pulsus alternans  Pulsus paradoxus  Anacrotic pulse  Dicrotic pulse
  15. 15. Collapsing pulse/Water-hammer pulse/Corrigan’s pulse
  16. 16. 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
  17. 17. 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
  18. 18. Collapses in early diastole – backflow through aortic valve Exaggerated at the radial artery by liftng the arm.
  19. 19. Slow Rising Pulse  Gradual upstroke with a reduced peak  Occur late in systole  Seen in severe aortic stenosis
  20. 20. Mechanism Fixed obstruction restricts the rate at which blood can be ejected from the left ventricle.
  21. 21. Pulsus Bisferiens  Increased pulse with double systolic peak seperated by a distinct mid-systolic dip.  Causes: Aortic regurgitation Concomitant aortic stenois and regurgitation
  22. 22. 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
  23. 23. Pulsus bigeminus  Regular alteration of pulse pressure amplitude.  Caused by premature ventricular contraction that follows each regular beat  Occurs in: AV block Sinoatrial block withVentricular Escape
  24. 24. Pulsus alternans  Beat-to-beat variation in pulse volume with a normal rhythm.  Rare  Occurs in : Advanced heart failure Toxic myocarditis ParoxysmalTachycardias Following Premature beat
  25. 25. 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
  26. 26. Anacrotic Pulse  Slow rising  Double beating pulse  Both waves felt in systole Seen in Aortic Stenosis
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. CAUSES OF ABSENT RADIAL PULSE  Anatomical abnormality  Severe atherosclerosis  Takayasu arteritis (Pulseless disease)  Embolism in radial artery  Death
  31. 31. 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
  32. 32. 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
  33. 33. THANK YOU

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