Riegel's pulse


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pulse

 [puls]
2. the beat of the heart as felt through the walls of a peripheral artery, such as that felt in the radial artery at the wrist. Other sites for pulse measurement include the side of the neck (carotid artery), the antecubital fossa (brachial artery), the temple (temporal artery), the anterior side of the hip bone (femoral artery), the back of the knee (popliteal artery), and the instep (dorsalis pedis artery).

What is felt is not the blood pulsing through the arteries (as is commonly supposed) but a shock wave that travels along the walls of the arteries as the heart contracts. This shock wave is generated by the pounding of the blood as it is ejected from the heart under pressure. It is analogous to the hammering sound heard in steam pipes as the steam is forced into the pipes under pressure. A pulse in the veins is too weak to be felt, although sometimes it is measured by sphygmograph (see below); the tracing obtained is called a phlebogram.

The pulse is usually felt just inside the wrist below the thumb by placing two or three fingers lightly upon the radial artery. The examiner's thumb is never used to take a pulse because its own pulse is likely to be confused with that of the patient. Pressure should be light; if the artery is pressed too hard, the pulse will disappear entirely. The number of beats felt in exactly 1 minute is the pulse rate.

In taking a pulse, the rate, rhythm, and strength or amplitude of the pulse are noted. The average rate in an adult is between 60 and 100 beats per minute. The rhythm is checked for possible irregularities, which may be an indication of the general condition of the heart and the circulatory system.

The amplitude of a pulse can range from totally impalpable to bounding and full; however, such terms are vague and subject to misinterpretation. To provide a more standardized description of pulse amplitude some agencies and hospitals use a scale that provides a more objective evaluation and reporting of the force of a pulse. On such a scale zero would mean that the pulse cannot be felt; +1 would indicate a thready, weak pulse that is difficult to palpate, fades in and out, and is easily obliterated with slight pressure; +2 would be a pulse that requires light palpation but once located would be stronger than a +1; +3 would be considered normal; and a +4 pulse would be one that is strong, bounding, easily palpated, and perhaps hyperactive, and could indicate a pathological condition such as aortic regurgitation.

If a pulse is noted to be weaker during inhalation and stronger during exhalation (pulsus paradoxus), this could indicate either greater reduction in the flow of blood to the left ventricle than is normal, as in constrictive pericarditis or pericardial effusion, or a grossly exaggerated inspiratory maneuver, as in tracheal obstruction, asthma, or emphysema.

An instrument for registering the movements, form, and force of the arterial pulse is called a sphygmograph. The sphygmographic tracing (or pulse tracing) consists of a curve having a sudden rise (primary elevation) followed by a sudden fall, after which there is a gradual descent marked by a number of secondary elevations.
Pulses palpated during assessment of the arterial system.
abdominal pulse that over the abdominal aorta.
alternating pulse one with regular alteration of weak and strong beats without changes in cycle length. Called also pulsus alternans.
anacrotic pulse one in which the ascending limb of the tracing shows a transient drop in amplitude, or a notch.
anadicrotic pulse one in which the ascending limb of the tracing shows two extra small waves or notches.
anatricrotic pulse one in which the ascending limb of the tracing shows three extra small waves or notches.
apical pulse the pulse over the apex of the heart, as heard through a stethoscope or palpated.
atrial venous pulse (atriovenous pulse) a venous pulse in the neck that has an accentuated a wave during atrial systole, owing to increased force of contraction of the right atrium; a characteristic of tricuspid stenosis.
bigeminal pulse one in which two beats occur in rapid succession, the groups of two being separated by a longer interval, usually related to regularly occurring ventricular premature beats. Called also pulsus bigeminus.
bisferious pulse pulsus bisferiens.
brachial pulse that which is felt over the brachial artery at the inner aspect of the elbow; palpated before taking blood pressure to determine location for the stethoscope.
capillary pulse Quincke's pulse.
carotid pulse the pulse felt over the carotid artery, which lies between the larynx and the sternocleidomastoid muscle in the neck; frequently used to assess effectiveness of cardiac massage during cardiopulmonary resuscitation. It can be felt by pushing the muscle to the side and pressing against the larynx, or, if the patient is dyspneic, by palpating the pulse at the groove in the muscle.
catadicrotic pulse one in which the descending limb of the tracing shows two small notches.
catatricrotic pulse one in which the descending limb of the tracing shows three small additional waves or notches.
Corrigan's pulse a jerky pulse with full expansion and sudden collapse occurring in aortic regurgitation; called also water-hammer pulse.
dicrotic pulse a pulse characterized by two peaks, the second peak occurring in diastole and being an exaggeration of the dicrotic wave; called also pulsus bisferiens.
dorsalis pedis pulse the pulse felt on the top of the foot, between the first and second metatarsal bones. In 8 to 10 per cent of the population this pulse cannot be detected.
entoptic pulse a subjective sensation of seeing a flash of light in the dark with each heart beat.
femoral pulse one located where the femoral artery passes through the groin in the femoral triangle.
funic pulse the arterial tide in the umbilical cord.
hard pulse (high-tension pulse) one with a gradual impulse, long duration, slow subsidence, and a firm state of the artery between beats.
jerky pulse one in which the artery is suddenly and markedly distended.
paradoxical pulse one that markedly decreases in amplitude during inhalation, as often occurs in constrictive pericarditis.
pistol-shot pulse Corrigan's pulse.
plateau pulse one that is slowly rising and sustained.
popliteal pulse one palpated in the popliteal fossa, most easily detected when the patient is lying prone with the knee flexed about 45 degrees.
posterior tibial pulse a pulse felt over the posterior tibial artery just posterior to the ankle bone on the inner aspect of the ankle.
quick pulse one that strikes the finger smartly and leaves it quickly; called also pulsus celer.
Quincke's pulse alternate blanching and flushing of the skin that may be elicited in several ways, such as by pressing on the end of the nail and observing the nail bed or skin at the root of the nail. It is caused by pulsation of subpapillary arteriolar and venous plexuses and is sometimes seen in aortic insufficiency, although it may occur in normal persons under certain conditions. Called also capillary pulse (because it was formerly thought to be due to pulsations in the capillaries) and Quincke's sign.
radial pulse that felt over the radial artery at the wrist.
Riegel's pulse one that is diminished during respiration.
slow pulse one with less than the usual number of pulsations per minute; called also vagus pulse and pulsus tardus.
thready pulse one that is very fine and scarcely perceptible.
tricrotic pulse one in which the tracing shows three marked expansions in one beat of the artery.
trigeminal pulse one with a pause after every third beat.
vagus pulse slow pulse.
venous pulse the pulsation over a vein, especially over the right jugular vein.
water-hammer pulse Corrigan's pulse.
wiry pulse a small, tense pulse.

pulse

(puls) [L. pulsus, beating]
1. Rate, rhythm, condition of arterial walls, compressibility and tension, and size and shape of the fluid wave of blood traveling through the arteries as a result of each heartbeat.
2. Rhythmical throbbing.
Enlarge picture
PULSES
3. Throbbing caused by the regular contraction and alternate expansion of an artery as the wave of blood passes through the vessel; the periodic thrust felt over arteries in time with the heartbeat. See: illustration

A tracing of this is called a sphygmogram and consists of a series of waves in which the upstroke is called the anacrotic limb, and the downstroke (on which is normally seen the dicrotic notch), the catacrotic limb.

The normal resting pulse in adults is between 60 and 100 beats per minute. The resting pulse is faster, for example, in febrile patients, anemic or hypovolemic persons, persons in shock, and patients who have taken drugs that stimulate the heart, such as theophylline, caffeine, nicotine, or cocaine. It may be slower in well-trained athletes; in patients using beta blockers, calcium channel blockers, or other agents; and during sleep or deep relaxation.

Patient care

In patients complaining of chest pain, pulses should be assessed in at least two extremities (e.g., both radial arteries). A strong pulse on the right side with a weak one on the left may suggest an aortic dissection or a stenosis of the left subclavian artery. Young patients with high blood pressure should have pulses assessed simultaneously at the radial and femoral artery because a significant delay in the femoral pulse may suggest coarctation of the aorta. Patients with recent symptoms of stroke or claudication should have pulses checked at the carotid, radial, femoral, popliteal, and posterior tibial arteries, to see whether any palpable evidence of arterial insufficiency exists at any of these locations. If a decreased pulse is detected, further evaluation might include ultrasonography or assessments of the ankle brachial index. Patients who are lightheaded or dizzy or who notice palpitations may have detectable premature beats or other pulse irregularities (e.g., the irregularly irregular pulse of atrial fibrillation).

abdominal pulse

A palpable pulse felt between the xiphoid process and the navel. This is produced by the pulse of the abdominal aorta.

alternating pulse

A pulse with alternating weak and strong pulsations.
Synonym: pulsus alternans

anacrotic pulse

A pulse showing a secondary wave on the ascending limb of the main wave.

anadicrotic pulse

A pulse wave with two small notches on the ascending portion.

apical pulse

A pulse felt or heard over the part of the chest wall that lies over the apex of the heart. In healthy people this is roughly located at the left mid-clavicular line in the fourth intercostal space.
See: Pulse: Apical

asymmetrical radial pulse

Unequal pulse.

basal pulse

Resting pulse.

bigeminal pulse

A pulse in which two regular beats are followed by a longer pause.
Synonym: coupled pulse

bisferiens pulse

A pulse marked by two systolic peaks on the pulse waveform. It is characteristic of aortic regurgitation (with or without aortic stenosis) and hypertrophic cardiomyopathy.

bounding pulse

A pulse that reaches a higher intensity than normal, then disappears quickly. Best detected when the arm is held aloft.
Synonym: collapsing pulse

brachial pulse

A pulse felt in the brachial artery.
See: Pulse: Brachial

capillary pulse

Visible inflow and outflow of blood from the nailbed. It is a finding in patients with aortic regurgitation when their fingernails or toenails are gently depressed by the examiner's finger. Synonym: Quincke's pulse

carotid pulse

A pulse felt in the carotid artery.
See: Pulse: Carotid

catacrotic pulse

A pulse showing one or more secondary waves on the descending limb of the main wave.

catadicrotic pulse

A pulse wave with two small notches on the descending portion.

central pulse

A pulse recorded near the origin of the carotid or subclavian arteries.

collapsing pulse

Bounding pulse.

Corrigan's pulse

See: waterhammer pulse

coupled pulse

Bigeminal pulse.

dicrotic pulse

A pulse with a double beat, one heartbeat for two arterial pulsations, or a seemingly weak wave between the usual heartbeats. This weak wave should not be counted as a regular beat. It is indicative of low arterial tension and is noted in fevers.

dorsalis pedis pulse

A pulse felt over the dorsalis pedis artery of the foot.
See: Pulse: Dorsalis Pedis

entoptic pulse

Intermittent subjective sensations of light that accompany the heartbeat.

femoral pulse

A pulse felt over the femoral artery.
See: Pulse: Femoral

filiform pulse

Thready pulse.

hepatic pulse

A pulse due to expansion of veins of the liver at each ventricular contraction.

intermediate pulse

A pulse recorded in the proximal portions of the carotid, femoral, and brachial arteries.

intermittent pulse

A pulse in which occasional beats are skipped, caused by conditions such as premature atrial contractions, premature ventricular contractions, and atrial fibrillation. Synonym: irregular pulse

irregular pulse

Intermittent pulse.

irregularly irregular pulse

The erratic, unpredictable pulse present in atrial fibrillation.

jugular pulse

A venous pulse felt in the jugular vein.

Kussmaul's pulse

See: Kussmaul, Adolph

monocrotic pulse

A pulse in which the sphygmogram shows a simple ascending and descending uninterrupted line and no dicrotism.

nail pulse

A visible pulsation in the capillaries under the nails.

paradoxical pulse

A decrease in the strength of the pulse (and of systolic blood pressure) during inspiration, a condition that may be esp. prominent in severe asthma, cardiac tamponade, obstructive sleep apnea, croup, and other conditions that alter pressure relationships within the chest.
Synonym: Kussmaul's pulse; pulsus paradoxus

pulse parvus

Pulsus parvus et tardus.

peripheral pulse

A pulse recorded in the arteries (radial or pedal) in the distal portion of the limbs.

pistol-shot pulse

A pulse resulting from rapid distention and collapse of an artery as occurs in aortic regurgitation.

plateau pulse

A pulse associated with an increase in pressure that slowly rises but is maintained.

popliteal pulse

A pulse felt over the popliteal artery.
See: Pulse: Popliteal

Quincke's pulse

See: capillary pulse

radial pulse

A pulse felt over the radial artery.
See: Pulse: Radial

rapid pulse

Tachycardia.

regular pulse

A pulse felt when the force and frequency are the same (i.e., when the length of beat and number of beats per minute and the strength are the same).

respiratory pulse

Alternate dilatation and contraction of the large veins of the neck occurring simultaneously with inspiration and expiration.

resting pulse

A pulse rate obtained while an individual is at rest and calm.
Synonym: basal pulse

retrosternal pulse

A venous pulse felt over the suprasternal notch.

Riegel's pulse

See: Riegel's pulse

running pulse

A weak, rapid pulse with one wave continuing into the next.

short pulse

A pulse with a short, quick systolic wave.

slow pulse

A pulse rate that is less than 60 beats per minute.

small pulse

See: pulsus parvus et tardus

soft pulse

A pulse that may be stopped by moderate digital compression.

tense pulse

A full but not bounding pulse.

thready pulse

A fine, scarcely perceptible pulse. Synonym: filiform pulse

tremulous pulse

A pulse in which a series of oscillations is felt with each beat.

tricrotic pulse

A pulse with three separate expansions during each heartbeat.

trigeminal pulse

A pulse with a longer or shorter interval after each three beats because the third beat is an extrasystole.

triphammer pulse

Waterhammer pulse.

undulating pulse

A pulse that seems to have several successive waves.

unequal pulse

A pulse in which beats vary in force. Synonym: asymmetrical radial pulse

vagus pulse

A slow pulse resulting from parasympathetic influence on heart rate, mediated by the vagus nerve.

venous pulse

A pulse in a vein, esp. one of the large veins near the heart, such as the internal or external jugular. Normally it is undulating and scarcely palpable. In conditions such as tricuspid regurgitation, it is pronounced.

vermicular pulse

A small, frequent pulse with a wormlike feeling.

waterhammer pulse

A pulse with a powerful upstroke and then sudden disappearance; a hallmark of aortic regurgitation.
Synonym: triphammer pulse; Corrigan's pulse

wiry pulse

A tense pulse that feels like a wire or firm cord.

Riegel's pulse

a pulse that is smaller during respiration.