1.
WELCOME TO THE SEMINAR
Presenter:
DR. RENESHA ISLAM
Resident, Year 1
Paediatric Haematology &
Oncology

2.
EXAMINATION OF PULSE
AND BLOOD PRESSURE
IN CHILDREN

3.
What is Pulse ?
•Expansion and elongation of arterial wall
imparted by the column of blood, passively
produced by pressure changes during
ventricular systole and diastole.

4.
IMPORTANCE:
-Information about-
• vessel wall condition.
•Rough estimation of SBP.
•State of the heart and circulation &
-Detection and diagnosis of Arrythmia.

5.
PURPOSES
OF TAKING PULSERATE

6.
FACTORS AFFECTING THEPULSE

7.
How to feel the Pulse
Radial pulse:
oThe 3 middle fingers are used
oThe palmar surface of the
fingers overlies the radial artery
and encircles the wrist
oAt first the artery is
completely occluded, then
gradually the pressure released
until maximum feeling of the
pulse wave is perceived.

8.
Brachial Artery
oRest the patient arm with
elbow extended & palm up.
oUse the thumb of the
opposite hand.
oCup the hand under the
patient elbow.
oFeel the pulse just medial
to biceps tendon.

9.
Carotid Artery
o The patient lies down with the head
of the bed elevated 30 degrees.
o Carotid pulsations may be visible
just medial to sternocleidomastoid.
o Place the left thumb on the right
carotid in the lower third of the
neck at the level of the cricoid
cartilage, just inside the medial
border of the sternocleidomastoid
and press posteriorly.
o Never press both carotids at same
time.

10.
Femoral Pulse
Press deeply below
the inguinal ligament
and about mid way
between Anterior
Superior Iliac Spine
and Symphysis Pubis.

11.
Popliteal Pulse
oPatient’s knee should
be flexed.
oPlace the finger tips of
both hands so that they
meet in the middle line
behind the knee and
press them deeply in
the popliteal fossa.

12.
Posterior Tibial
Felt behind and slightly below the
medial malleolus of the ankle.

13.
Dorsalis Pedis
o Feel the dorsum of the foot just lateral to the
extensor tendon of the big toe.
o If cannot feel the pulse, explore the dorsum of the
foot more laterally.

14.
ASSESSMENT OF PULSE
1. RATE (beats/min)
- Tachycardia (>100/min)
- Bradycardia (<60/min)
2. RHYTHM
- Regular
- Regularly Irregular (2nd degree heart block)
- Irregularly Irregular(Atrial Fibrillation, Ectopic beats)
3. Volume
4. Symmetry

15.
5. CHARACTER
-Catacrotic Pulse
- Anacrotic Pulse
- Dicrotic Pulse
- Pulsus Bisferiens
- Pulsus Alternans
- Pulsus Bigeminus
- Pulsus Paradoxus
- Collapsing Pulse
6.Radio-radial and radio-femoral delay
7.Condition of vessel wall

16.
ABNORMAL FINDINGS INPULSE
RATE
1. T
achycardia(PulseRate>100 bpm)
2.Bradycardia(Pulse Rate<60 bpm)

17.
TACHYCARDIA
Sinus rhythm Arrhythmia
Exercise Atrial Fibrillation
Infants Atrial flutter
Excitement/Anxiety VentricularT
achycardia
Pheochromocytoma
Fever
Hyperthyroidism
MEDICATION:
Ca channelblockers(Nifedipine)
Sympathomimetics(e.g.salbutamol)
Vasodilators

18.
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

19.
If Irregular:
•Occasionally irregular
•Regularly Irregular
•Irregularly Irregular

20.
• ABNORMAL FINDINGS IN RHYTHM
• If Irregular:
• Occasionally irregular
• Regularly Irregular
• Irregularly Irregular

21.
CAUSES OF RADIOFEMORAL DELAY
1. Coarctation of aorta
2. Artherosclerosis of aorta
3. Thrombosis or embolism
of aorta
4. Aortoarteritis

22.
CATACROTIC PULSE
Normal arterial pulse:
S (Starting point)-Starting point of arterial pulse-
wave. Aortic valve opens and the blood of the
left ventricle is discharged.
P (Percussion wave) -Wave caused from LV
ejection that increase the arterial wall linearly.
T (Tidal wave)-Reflected wave from the small
artery.
C (Incisura)-End-point of systolic phase, then
aortic valve is closed.
D (Dicrotic wave)-Reflective oscillatory wave
occurred from the blood crash into aortic valve
by blood pressure of aorta.
*wavy pattern is not felt in healthy since it is
obliterated by normal vascular tone

23.
Anacrotic Pulse
Low amplitude pulse
Slow rise and late
systolic peak.
 Seen inAortic Stenosis
 Mechanism:Fixed
obstruction restricts the
rate at which blood can be
ejectedfrom the left
ventricle.

24.
Dicrotic Pulse
T
wice beating
First wavein systole,
second wavei
n diastole
Occur duetoverylowstroke
volume with decreased
peripheral resistance.
Seen in:
Fever (e.g.typhoid fever)
CCF
CardiacTamponade

25.
Collapsing pulse
Sharp rise
Ill-sustained
Sharp fall
Wide pulse
pressure(>80mmHg)
 collapsing pulse is found
in:
 Aortic regurgitation
 PDA
 Large arterio-venous
communication

26.
Mechanism
Inaorticregurgitation,duringdiastole:
 Leftventricle receivesnormal
pulmonaryvenous return + portion
ofblood ejectedintotheaorta=>
largestrokevolume- vigorously
ejected=>rapidlyrisingcarotid pulse.
 Collapses in early diastole –
backflowthrough aortic valve
 Exaggerated atthe radialartery by
liftng the arm.

27.
Pulsus Bisferiens
Increased pulse with
double systolic pea
k
seperated by adistinct
mid-systolicdip.
Causes:
Aortic regurgitation
Concomitant aortic
stenois and
regurgitation

28.
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

29.
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

30.
Pulsus Paradoxus
Exaggeration of the normal variability of pulse volume with breathing.
Inspiratory decline in systolic pressure greater than10mm Hg.
Occurs in:
Cardiac tamponade
Constrictive pericarditis
Percardial effusion

31.
APEX PULSE DEFICIT
Difference between HR and PR
1. Atrial Fibrillation (>10/min)
2. Multiple ectopics (<10/min)

32.
CAUSES OF ABSENT RADIAL PULSE
1. Anatomical abnormality
2. Severe atherosclerosis
3. Takayasu arteritis (Pulseless disease)
4. Embolism in radial artery