Pulse

Pulse

Overview
In medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, one's pulse represents the tactile arterial palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...

 of the heartbeat
Cardiac cycle
The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. The frequency of the cardiac cycle is described by the heart rate. Each beat of the heart involves five major stages...

 by trained fingertips. The pulse may be palpated in any place that allows an artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....

 to be compressed against a bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...

, such as at the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...

 (carotid artery
Carotid artery
Carotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...

), at the wrist
Wrist
In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...

 (radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...

), behind the knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...

 (popliteal artery
Popliteal artery
In human anatomy, the popliteal artery is defined as the extension of the "superficial" femoral artery after passing through the adductor canal and adductor hiatus above the knee...

), on the inside of the elbow
Elbow
The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....

 (brachial artery
Brachial artery
The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

), and near the ankle joint (posterior tibial artery). The pulse can also be measured by listening to the heart beat directly (auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...

), traditionally using a stethoscope
Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...

.

The pulse is a decidedly low tech/high yield and antiquated term still useful at the bedside in an age of computational analysis of cardiac performance.
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Encyclopedia
In medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, one's pulse represents the tactile arterial palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...

 of the heartbeat
Cardiac cycle
The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. The frequency of the cardiac cycle is described by the heart rate. Each beat of the heart involves five major stages...

 by trained fingertips. The pulse may be palpated in any place that allows an artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....

 to be compressed against a bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...

, such as at the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...

 (carotid artery
Carotid artery
Carotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...

), at the wrist
Wrist
In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...

 (radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...

), behind the knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...

 (popliteal artery
Popliteal artery
In human anatomy, the popliteal artery is defined as the extension of the "superficial" femoral artery after passing through the adductor canal and adductor hiatus above the knee...

), on the inside of the elbow
Elbow
The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....

 (brachial artery
Brachial artery
The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

), and near the ankle joint (posterior tibial artery). The pulse can also be measured by listening to the heart beat directly (auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...

), traditionally using a stethoscope
Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...

.

Physiology


The pulse is a decidedly low tech/high yield and antiquated term still useful at the bedside in an age of computational analysis of cardiac performance. Claudius Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...

 was perhaps the first physiologist to describe the pulse. The pulse is an expedient tactile method of determination of systolic
Systole (medicine)
Systole is the contraction of the heart. Used alone, it usually means the contraction of the left ventricle.In all mammals, the heart has 4 chambers. The left and right ventricles pump together. The atria and ventricles pump in sequence...

 blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 to a trained observer. Diastolic blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 is non-palpable and unobservable by tactile methods, occurring between heartbeats.

Pressure waves generated by the heart in systole
Systole (medicine)
Systole is the contraction of the heart. Used alone, it usually means the contraction of the left ventricle.In all mammals, the heart has 4 chambers. The left and right ventricles pump together. The atria and ventricles pump in sequence...

 moves the arterial walls. Forward movement of blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 occurs when the boundaries are pliable and compliant. These properties form enough to create a palpable pressure wave.

The heart rate
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....

 may be greater or lesser than the pulse rate depending upon physiologic demand. In this case, the heart rate is determined by auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...

 or audible sounds at the heart apex, in which case it is not the pulse. The pulse deficit (difference between heart beats and pulsations at the periphery) is determined by simultaneous palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...

 at the radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...

 and auscultation at the heart apex.

Pulse velocity, pulse deficits and much more physiologic data are readily and simplistically visualized by the use of one or more arterial catheters connected to a transducer
Transducer
A transducer is a device that converts one type of energy to another. Energy types include electrical, mechanical, electromagnetic , chemical, acoustic or thermal energy. While the term transducer commonly implies the use of a sensor/detector, any device which converts energy can be considered a...

 and oscilloscope
Oscilloscope
An oscilloscope is a type of electronic test instrument that allows observation of constantly varying signal voltages, usually as a two-dimensional graph of one or more electrical potential differences using the vertical or 'Y' axis, plotted as a function of time,...

. This invasive technique has been commonly used in intensive care since the 1970s.

The rate of the pulse is observed and measured by tactile or visual means on the outside of an artery and is recorded as beats per minute or BPM.

The pulse may be further indirectly observed under light
Light
Light or visible light is electromagnetic radiation that is visible to the human eye, and is responsible for the sense of sight. Visible light has wavelength in a range from about 380 nanometres to about 740 nm, with a frequency range of about 405 THz to 790 THz...

 absorbances of varying wavelengths with assigned and inexpensively reproduced mathematical ratios. Applied capture of variances of light signal from the blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 component hemoglobin
Hemoglobin
Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...

 under oxygenated vs. deoxygenated conditions allows the technology of pulse oximetry
Pulse oximetry
Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot....

.

Normal Pulse Rates


Normal pulse rates at rest, in beats per minute (BPM):
   newborn       1 — 12 months       1 — 2 years       2 — 6 years       7 — 12 years       13 years — adults       adult athletes   
120 - 160 80 - 140 80 - 130 75 - 120 75 - 110 60 - 100 40 - 60


The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

s can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting.

Evaluation


Several pulse patterns can be of clinical significance. These include:
  • Pulsus alternans
    Pulsus alternans
    Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.-Pathophysiology:...

    : an ominous medical sign that indicates progressive systolic heart failure. To trained fingertips, the examiner notes a pattern of a strong pulse followed by a weak pulse over and over again. This pulse signals a flagging effort of the heart to sustain itself in systole.
  • Pulsus bigeminus
    Pulsus bigeminus
    Pulsus bigeminus is a cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first. It is caused by premature contractions , usually of the ventricles, after every other beat, so called extrasystoles...

    : indicates a pair of hoofbeats within each heartbeat. Concurrent auscultation
    Auscultation
    Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...

     of the heart may reveal a gallop rhythm
    Gallop rhythm
    A gallop rhythm refers to a rhythm of the heart on auscultation. It includes three or four sounds, thus resembling the sounds of a gallop....

     of the native heartbeat.
  • Pulsus bisferiens
    Pulsus bisferiens
    In medicine, pulsus bisferiens, also bisferious pulse or biphasic pulse, is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice...

    : an unusual physical finding typically seen in patients with aortic valve diseases. If the aortic valve does not normally open and close, trained fingertips will observe two pulses to each heartbeat instead of one.
  • Pulsus tardus et parvus
    Pulsus tardus et parvus
    In medicine, pulsus tardus et parvus, also pulsus parvus et tardus, slow-rising pulse and anacrotic pulse, is a sign where, upon palpation, the pulse is weak/small , and late relative to its usually expected character....

    : a slower than normal rise in the tactile pulse caused by an increasingly stiff aortic valve. Loss of compliance in the aortic valve makes it progressively harder to open, thus requiring increased generation of blood pressure in the left ventricle.
  • Pulsus paradoxus
    Pulsus paradoxus
    In medicine, a pulsus paradoxus , also paradoxic pulse or paradoxical pulse, is defined as an exaggeration of the normal variation during the inspiratory phase of respiration, in which the blood pressure declines as one inhales and increases as one exhales...

    : a condition in which some heartbeats cannot be detected at the radial artery during the inspiration phase of respiration. It is caused by an exaggerated decrease in blood pressure during this phase, and is diagnostic of a variety of cardiac and respiratory conditions of varying urgency.
  • Tachycardia
    Tachycardia
    Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...

    : an elevated resting heart rate. In general an electrocardiogram
    Electrocardiogram
    Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...

     (ECG) is required to identify the type of tachycardia.


The strength of the pulse can also be reported:
  • 0 = Absent
  • 1 = Barely palpable
  • 2 = Easily palpable
  • 3 = Full
  • 4 = Aneurysmal or Bounding pulse
    Bounding pulse
    Bounding pulse is a medical sign characterized as a leaping and forceful pulse that quickly disappears. To feel a bounding pulse, the radial artery is lightly palpated at the distal palmar edge. It is best detected when the arm is held aloft....



A collapsing pulse is a sign of hyperdynamic circulation
Hyperdynamic circulation
Hyperdynamic circulation is abnormally increased circulatory volume. Systemic vasodilation and the associated decrease in peripheral vascular resistance results in decreased pulmonary capillary wedge pressure and decreased blood pressure, often presenting with a collapsing pulse...

.

Upper limb


  • Axillary pulse: located inferiorly of the lateral wall of the axilla
  • Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery
    Brachial artery
    The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

    )
  • Radial pulse: located on the lateral of the wrist (radial artery
    Radial artery
    In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...

    ). It can also be found in the anatomical snuff box
    Anatomical snuff box
    The anatomical snuffbox is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor...

    .
  • Ulnar pulse: located on the medial of the wrist (ulnar artery
    Ulnar artery
    The ulnar artery is the main blood vessel, with oxygenated blood, of the medial aspect of the forearm. It arises from the brachial artery and terminates in the superficial palmar arch, which joins with the superficial branch of the radial artery...

    ).

Chinese
Culture of China
Chinese culture is one of the world's oldest and most complex. The area in which the culture is dominant covers a large geographical region in eastern Asia with customs and traditions varying greatly between towns, cities and provinces...

 medicine has focused on the pulse in the upper limbs for several centuries. The concept of Pulse Diagnosis
Pulse diagnosis
Pulse diagnosis is a technique used in traditional medicines such as in Ayurveda, Chinese medicine, or early Greek medicine.In Ayurveda, advocates claim that by taking a pulse examination, humoral imbalances such as the three Doshas - Vata, Pitta, and Kaphha - can be diagnosed.In Traditional...

 is essentially a treatise based upon palpation and observations of the radial and ulnar volar pulses at the readily accessible wrist.

Lower limb

  • Femoral pulse: located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine (femoral artery
    Femoral artery
    The femoral artery is a general term comprising a few large arteries in the thigh. They begin at the inguinal ligament and end just above the knee at adductor canal or Hunter's canal traversing the extent of the femur bone....

    ).
  • Popliteal pulse: Above the knee in the popliteal fossa, found by holding the bent knee. The patient bends the knee at approximately 124°, and the physician holds it in both hands to find the popliteal artery in the pit behind the knee (Popliteal artery
    Popliteal artery
    In human anatomy, the popliteal artery is defined as the extension of the "superficial" femoral artery after passing through the adductor canal and adductor hiatus above the knee...

    ).
  • Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus (dorsalis pedis artery
    Dorsalis pedis artery
    In human anatomy, the dorsalis pedis artery , is a blood vessel of the lower limb that carries oxygenated blood from the dorsal surface of the foot. It arises at the anterior aspect of the ankle joint and is a continuation of the anterior tibial artery...

    ).
  • Tibialis posterior pulse: located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the medial malleolus (posterior tibial artery
    Posterior tibial artery
    The posterior tibial artery of the lower limb carries blood to the posterior compartment of the leg and plantar surface of the foot, from the popliteal artery...

    ). It is easily palpable over Pimenta's Point
    Pimenta's Point
    Pimenta's Point is an anatomical landmark for easy location of the posterior tibial artery or tibialis posterior artery . An imagined line is drawn between the bony prominence of the medial malleolus and the insertion of the achilles tendon...

    .

Head/neck


  • Carotid pulse: located in the neck (carotid artery
    Carotid artery
    Carotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...

    ). The carotid artery should be palpated gently and while the patient is sitting or lying down. Stimulating its baroreceptors with low palpitation can provoke severe bradycardia
    Bradycardia
    Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

     or even stop the heart in some sensitive persons. Also, a person's two carotid arteries should not be palpated at the same time. Doing so may limit the flow of blood to the head, possibly leading to fainting or brain ischemia
    Ischemia
    In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...

    . It can be felt between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage.
  • Facial pulse: located on the mandible (lower jawbone) on a line with the corners of the mouth (facial artery
    Facial artery
    The facial artery is a branch of the external carotid artery that supplies structures of the superficial face.-Structure:...

    ).
  • Temporal pulse: located on the temple
    Temple (anatomy)
    Temple indicates the side of the head behind the eyes. The bone beneath is the temporal bone as well as part of the sphenoid bone.-Anatomy:Cladists classify land vertebrates based on the presence of an upper hole, a lower hole, both, or neither in the cover of dermal bone which formerly covered the...

     directly in front of the ear (superficial temporal artery
    Superficial temporal artery
    In human anatomy, the superficial temporal artery is a major artery of the head. It arises from the external carotid artery when it bifurcates into the superficial temporal artery and maxillary artery....

    ).

Torso

  • Apical pulse: located in the 4.5th or 5th left intercostal space, just outside the mid-clavicular line. In contrast with other pulse sites, the apical pulse site is unilateral, and measured not under an artery, but below the heart
    Heart
    The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

    itself (more specifically, the apex of the heart).