Radial Pulse | Renal Exam - MedSchool
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Radial Pulse

 
 
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Heart Rate

    • How to Measure

    • Count the number of beats over 15, 30 or 60 seconds and multiply to estimate beats per minute.
      • Normal Range

      • 60 - 100bpm
    • Causes of Bradycardia (<60bpm)

    • Physiological - high cardiac fitness
    • Beta blockers
    • Hypothyroidism
    • Raised intracranial pressure
    • Heart block
    • Sick sinus syndrome
    • Causes of Tachycardia (>100bpm)

    • Sinus tachycardia - physical exertion, infection, anxiety, thyrotoxicosis, stimulant drugs, shock
    • Atrial fibrillation / flutter - aberrant conduction, parenchymal damage
    • Supraventricular tachycardia - aberrant conduction pathways/ re-entry

Rhythm

    • How to Assess

    • Feel the pulse for at least thirty seconds and determine whether the beats fall in time or are irregular.
    • Interpretation

    • Regular: sinus rhythm
    • Sinus arrhythmia: rhythmic variations in vagal tone with respiration
    • Regularly irregular (regular heart rate with occasional missed or extra beats): second degree heart block, premature ventricular contractions
    • Irregularly irregular: atrial fibrillation

Character

  • Weak pulseAtherosclerosis, tamponade, LV failure, cervical rib, aortic dissection, dehydration
  • Strong pulseExercise, pregnancy, anxiety, fever, hyperthyroidism, acute alcoholism
  • Waterhammer / collapsing pulse: strong pulse with sudden drop in intensity following its peakAortic regurgitation, patent ductus arteriosus
  • Pulsus alternans: regular alternation between strong and weak beats, especially palpated in peripheral arteriesLeft ventricular failure
  • Bisferiens pulse (double beating pulse)Aortic regurgitation
  • Bigeminal pulse: two close beats followed by a pause.Premature ventricular complexes
  • Pulsus tardis & parvis: weak pulse with a delayed systolic peak.Aortic stenosis
  • Pulsus paradoxus: weak pulse during inspiration, strong during expirationConstrictive pericarditis, tamponade, PE, tension PTX, asthma / COPD, shock, pregnancy, obesity

Postural Tachycardia

    • How To Elicit

    • Measure the heart rate with the patient lying down, and then remeasure it after the patient has been standing for one minute.
    • Interpretation

    • Postural tachycardia is present if there is a rise of >20bpm following standing.
    • Causes of Postural Tachycardia

    • Autonomic dysfunction
    • Low intravascular volume - blood / fluid / electrolyte loss
    • Vasodilation - nitrates, alcohol, fever
    • Cardiac impairment
    • Chronic disease - diabetes mellitus, chronic renal failure, chronic liver disease,
    • Brain tumour - paraneoplastic syndrome
Last updated on November 28th, 2019
 
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