Clinical Examination of Cardiovascular System For Medical Students

Discussion on blood pressure is not included here as a separate topic is dedicated to it. Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate. Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may be exaggerated in children. If the rhythm is totally irregular, it is likely to be atrial fibrillation. Patterned irregularity like pulsus bigeminus can occur due to ectopic beats or second degree atrioventricular block. Volume: Low volume pulse is noted in shock and severe aortic stenosis (Pulsus parvus). High volume pulse is felt in aortic regurgitation. 4. Character: A slow rising pulse is seen in aortic stenosis (Pulsus tardus). Collapsing pulse or water hammer pulse is a feature of severe aortic regurgitation. Water hammer was a toy in the Victorian period. Collapsing character of the pulse is better appreciated with the palm and having upper limb raised above the head. A bifid pulse with two peaks in systole is known as bisferiens pulse. It is noted in free aortic regurgitation and with a combination of aortic stenosis and aortic regurgitation. Pulsu...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs