medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
, a pulse represents the tactile
arterial
An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...
palpation
Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...
of the
cardiac cycle
The cardiac cycle is the performance of the human heart from the beginning of one heartbeat to the beginning of the next. It consists of two periods: one during which the heart muscle relaxes and refills with blood, called diastole, following ...
(heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an
artery
An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
to be compressed near the surface of the body, such as at the
neck
The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...
wrist
In human anatomy, the wrist is variously defined as (1) the Carpal bones, carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known ...
(
radial artery
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm.
Structure
The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the f ...
), at the
groin
In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial comp ...
(
femoral artery
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the f ...
), behind the
knee
In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...
(
popliteal artery
The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches ...
), near the
ankle joint
The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular join ...
(
posterior tibial artery
The posterior tibial artery of the lower limb is an artery that carries blood to the posterior compartment of the leg and plantar surface of the foot. It branches from the popliteal artery via the tibial-fibular trunk.
Structure
The poster ...
), and on foot (
dorsalis pedis artery
In human anatomy, the dorsalis pedis artery (dorsal artery of foot) is a blood vessel of the lower limb. It arises from the anterior tibial artery, and ends at the first intermetatarsal space (as the first dorsal metatarsal artery and the deep pl ...
). Pulse (or the count of arterial pulse per minute) is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat by
auscultation
Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hea ...
, traditionally using a stethoscope and counting it for a minute. The radial pulse is commonly measured using three fingers. This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches (
superficial
Superficial may refer to:
*Superficial anatomy, is the study of the external features of the body
*Superficiality, the discourses in philosophy regarding social relation
*Superficial charm, the tendency to be smooth, engaging, charming, slick and ...
and
deep
Deep or The Deep may refer to:
Places United States
* Deep Creek (Appomattox River tributary), Virginia
* Deep Creek (Great Salt Lake), Idaho and Utah
* Deep Creek (Mahantango Creek tributary), Pennsylvania
* Deep Creek (Mojave River tributary), ...
). The study of the pulse is known as ''sphygmology''.
Physiology
Claudius
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
was perhaps the first physiologist to describe the pulse. The pulse is an expedient
tactile
Tactile may refer to:
* Tactile, related to the sense of touch
* Haptics (disambiguation)
* Tactile (device), a text-to-braille translation device
See also
* Tangibility, in law
* Somatosensory system, where sensations are processed
* CD96
CD ...
Diastolic
Diastole ( ) is the relaxed phase of the cardiac cycle when the chambers of the heart are re-filling with blood. The contrasting phase is systole when the heart chambers are contracting. Atrial diastole is the relaxing of the atria, and ventricu ...
blood pressure is non-palpable and unobservable by tactile methods, occurring between heartbeats.
Pressure waves generated by the heart in
systole
Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun ...
move the arterial walls. Forward movement of
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
occurs when the boundaries are pliable and compliant. These properties form enough to create a palpable pressure wave.
The
heart rate
Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
may be greater or lesser than the pulse rate depending upon physiologic demand. In this case, the heart rate is determined by
auscultation
Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hea ...
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 is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...
at the
radial artery
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm.
Structure
The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the f ...
arterial catheter
An arterial line (also art-line or a-line) is a thin catheter inserted into an artery.
Use
Arterial lines are most commonly used in intensive care medicine and anesthesia to monitor blood pressure directly and in real-time (rather than by i ...
s connected to a
transducer
A transducer is a device that converts energy from one form to another. Usually a transducer converts a signal in one form of energy to a signal in another.
Transducers are often employed at the boundaries of automation, measurement, and contr ...
and
oscilloscope
An oscilloscope (informally a scope) is a type of electronic test instrument that graphically displays varying electrical voltages as a two-dimensional plot of one or more signals as a function of time. The main purposes are to display repetiti ...
. This invasive technique has been commonly used in
intensive care
Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes pro ...
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 absorbances of varying wavelengths with assigned and inexpensively reproduced mathematical ratios. Applied capture of variances of light signal from the blood component
hemoglobin
Hemoglobin (haemoglobin BrE) (from the Greek word αἷμα, ''haîma'' 'blood' + Latin ''globus'' 'ball, sphere' + ''-in'') (), abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein present in red blood cells (erythrocyte ...
under oxygenated vs. deoxygenated conditions allows the technology of
pulse oximetry
Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of ...
.
Characteristics
Rate
Normal pulse rates at rest, in beats per minute (BPM):
The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardias can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting.
Rhythm
A normal pulse is regular in rhythm and force. An irregular pulse may be due to
sinus arrhythmia
Sinus arrhythmia is a commonly encountered variation of ''normal'' sinus rhythm. Sinus arrhythmia characteristically presents with an irregular rate in which the variation in the R-R interval vary by more than 0.12 seconds (120 milliseconds). Addit ...
paroxysmal atrial tachycardia
Atrial tachycardia is a type of heart rhythm problem in which the heart's electrical impulse comes from an ectopic pacemaker (that is, an abnormally located cardiac pacemaker) in the upper chambers ( atria) of the heart, rather than from the sin ...
,
atrial flutter
Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate and is classified as a type of supraventricular tachycardia. Atrial f ...
, partial heart block etc. Intermittent dropping out of beats at pulse is called "intermittent pulse". Examples of ''regular'' intermittent (regularly irregular) pulse include
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. Look for a pattern of what appears to be a relatively normal QRS compl ...
,
second-degree atrioventricular block
Second-degree atrioventricular block (AV block) is a disease of the electrical conduction system of the heart. It is a conduction block between the atria and ventricles. The presence of second-degree AV block is diagnosed when one or more (but ...
. An example of ''irregular'' intermittent (irregularly irregular) pulse is atrial fibrillation.
Volume
The degree of expansion displayed by artery during diastolic and systolic state is called volume. It is also known as amplitude, expansion or size of pulse.
Hypokinetic pulse
A weak pulse signifies narrow
pulse pressure
Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Resting blood pressure is normally appro ...
. It may be due to low
cardiac output
In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
(as seen in
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
,
congestive cardiac failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, an ...
valvular heart disease
Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart). These ...
mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...
A bounding pulse signifies high pulse pressure. It may be due to low
peripheral resistance
Vascular resistance is the resistance that must be overcome to push blood through the circulatory system and create flow. The resistance offered by the systemic circulation is known as the systemic vascular resistance (SVR) or may sometimes be cal ...
(as seen in
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
,
anemia
Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, th ...
,
thyrotoxicosis
Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. ...
beriberi
Thiamine deficiency is a medical condition of low levels of thiamine (Vitamin B1). A severe and chronic form is known as beriberi. The two main types in adults are wet beriberi and dry beriberi. Wet beriberi affects the cardiovascular system, ...
,
liver cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...
), increased cardiac output, increased stroke volume (as seen in anxiety, exercise,
complete heart block
Third-degree atrioventricular block (AV block) is a medical condition in which the electrical impulse generated in the sinoatrial node (SA node) in the atrium of the heart can not propagate to the ventricles.
Because the impulse is blocked, an a ...
,
aortic regurgitation
Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a conseq ...
), decreased distensibility of arterial system (as seen in
atherosclerosis
Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheroma, atheromatous plaque. At onset there are usu ...
,
hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
and coarctation of aorta).
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 may refer to:
* Establishing limits on the behavior of a process or device, see Listing and approval use and compliance
* Bounding overwatch, a variety of military maneuver
* A cyclical type of jumping
Jumping or leaping is a for ...
Force
Also known as compressibility of pulse. It is a rough measure of
systolic blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
.
Tension
It corresponds to
diastolic blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
. A low tension pulse (pulsus mollis), the vessel is soft or impalpable between beats. In high tension pulse (pulsus durus), vessels feel rigid even between pulse beats.
Form
A form or contour of a pulse is palpatory estimation of
arteriogram
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is perform ...
. A quickly rising and quickly falling pulse (pulsus celer) is seen in aortic regurgitation. A slow rising and slowly falling pulse (pulsus tardus) is seen in aortic stenosis.
Equality
Comparing pulses and different places gives valuable clinical information.
A discrepant or unequal pulse between left and right radial artery is observed in anomalous or aberrant course of artery, coarctation of aorta,
aortitis
Aortitis is the inflammation of the aortic wall. The disorder is potentially life-threatening and rare. It is reported that there are only 1–3 new cases of aortitis per year per million people in the United States and Europe. Aortitis is most com ...
peripheral embolism
Arterial embolism is a sudden interruption of blood flow to an organ or body part due to an embolus adhering to the wall of an artery blocking the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmona ...
etc. An unequal pulse between upper and lower extremities is seen in coarctation to aorta, aortitis, block at bifurcation of aorta,
dissection of aorta
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of severe chest or ...
,
iatrogenic
Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...
trauma and
arteriosclerotic
Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheromatous plaque. At onset there are usually no sy ...
obstruction.
Condition of arterial wall
A normal artery is not palpable after flattening by digital pressure. A thick radial artery which is palpable 7.5–10 cm up the forearm is suggestive of arteriosclerosis.
Radio-femoral delay
In coarctation of aorta, femoral pulse may be significantly delayed as compared to radial pulse (unless there is coexisting aortic regurgitation). The delay can also be observed in supravalvar aortic stenosis.
Patterns
Several pulse patterns can be of clinically significance. These include:
* Dicrotic pulse: is characterized by two beats per cardiac cycle, one systolic and the other diastolic. Physiologically, the dicrotic wave is the result of reflected waves from the lower extremities and aorta. Conditions associated with low cardiac output and high systemic vascular resistance can produce a dicrotic pulse.
*
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
One explanation ...
: 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 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. Look for a pattern of what appears to be a relatively normal QRS compl ...
: indicates a pair of hoofbeats within each heartbeat. Concurrent
auscultation
Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hea ...
of the heart may reveal a
gallop rhythm
A gallop rhythm refers to a (usually abnormal) rhythm of the heart on auscultation. It includes three or four sounds, thus resembling the sounds of a Horse gait#Gallop, gallop.
The normal heart rhythm contains two audible heart sounds called S1 ...
of the native heartbeat.
*
Pulsus bisferiens
Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one. This reference illustrates the normal and abnormal spectral waveform. It is a sign (medicine), ...
: is characterized by two beats per cardiac cycle, both systolic, unlike the dicrotic pulse. It's 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'', also ''pulsus parvus et tardus'', slow-rising pulse and anacrotic pulse, is weak (parvus), and late (tardus) relative to its expected characteristics. It is caused by a stiffened aortic valve that makes it progressively harder to open, thus requiring increased generation of blood pressure in the left ventricle. It is seen in aortic valve stenosis.Toy, Eugene, et al. ''Case Files: Internal Medicine.'' McGraw-Hill Companies, Inc. 2007. Page 43. .
*
Pulsus paradoxus
Pulsus paradoxus, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop ...
: 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, such as
cardiac tamponade
Cardiac tamponade, also known as pericardial tamponade (), is the buildup of fluid in the pericardium (the sac around the heart), resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include those of obstructi ...
.
*
Tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ( ...
: an elevated resting heart rate. In general an electrocardiogram (ECG) is required to identify the type of tachycardia.
*
Pulsatile
In fluid dynamics, a flow with periodic variations is known as pulsatile flow, or as Womersley flow. The flow profiles was first derived by John R. Womersley (1907–1958) in his work with blood flow in arteries. The cardiovascular system of chor ...
This description of the pulse implies the intrinsic physiology of
systole
Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun ...
and
diastole
Diastole ( ) is the relaxed phase of the cardiac cycle when the chambers of the heart are re-filling with blood. The contrasting phase is systole when the heart chambers are contracting. Atrial diastole is the relaxing of the atria, and ventric ...
. Scientifically, systole and diastole are
force
In physics, a force is an influence that can change the motion of an object. A force can cause an object with mass to change its velocity (e.g. moving from a state of rest), i.e., to accelerate. Force can also be described intuitively as a p ...
s that expand and contract the pulmonary and systemic circulations.
*A collapsing pulse is a sign of
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, presen ...
.
Common palpable sites
Sites can be divided into peripheral pulses and central pulses. Central pulses include the carotid, femoral, and brachial pulses.
Upper limb
*Axillary pulse: located inferiorly of the lateral wall of the
axilla
The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...
*Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (
brachial artery
The brachial artery is the major blood vessel of the (upper) 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 ...
)
*Radial pulse: located on the lateral of the wrist (
radial artery
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm.
Structure
The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the f ...
). It can also be found in the
anatomical snuff box
The anatomical snuff box or snuffbox or foveola radialis 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. The name originates ...
.
*Ulnar pulse: located on the medial of the wrist (
ulnar artery
The ulnar artery is the main blood vessel, with oxygenated blood, of the medial aspects 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 ar ...
mid-inguinal point
The mid-inguinal point (MIP) is located on the inguinal ligament, halfway between the anterior superior iliac spine (ASIS) and the pubic symphysis. It is not to be confused with the midpoint of the inguinal ligament itself, which is located halfway ...
, halfway between the pubic symphysis and anterior superior iliac spine (
femoral artery
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the f ...
).
*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 health care provider holds it in both hands to find the popliteal artery in the pit behind the knee (
popliteal artery
The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches ...
).
*Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus (
dorsalis pedis artery
In human anatomy, the dorsalis pedis artery (dorsal artery of foot) is a blood vessel of the lower limb. It arises from the anterior tibial artery, and ends at the first intermetatarsal space (as the first dorsal metatarsal artery and the deep pl ...
).
*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
The posterior tibial artery of the lower limb is an artery that carries blood to the posterior compartment of the leg and plantar surface of the foot. It branches from the popliteal artery via the tibial-fibular trunk.
Structure
The poster ...
). It is easily palpable over
Pimenta's Point Pimenta's point is an anatomical landmark for easy location of the posterior tibial artery or tibialis posterior artery (a peripheral pulse on the inside of your ankle). An imagined line is drawn between the bony prominence of the medial malleolus a ...
.
Head and neck
*
Carotid pulse
In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid" in 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 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
Syncope, commonly known as fainting, or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from ...
or brain
ischemia
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
. 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
The facial artery (external maxillary artery in older texts) is a branch of the external carotid artery that supplies structures of the superficial face.
Structure
The facial artery arises in the carotid triangle from the external carotid arte ...
).
*Temporal pulse: located on the
temple
A temple (from the Latin ) is a building reserved for spiritual rituals and activities such as prayer and sacrifice. Religions which erect temples include Christianity (whose temples are typically called churches), Hinduism (whose temples ...
directly in front of the ear (
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 splits into the superficial temporal artery and maxillary artery.
Its pulse can be felt above the zygomatic a ...
).
Although the pulse can be felt in multiple places in the head, people should not normally hear their heartbeats within the head. This is called
pulsatile tinnitus
Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
, and it can indicate several medical disorders.
Torso
*Apical pulse: located in the 5th left intercostal space, 1.25 cm lateral to the
mid-clavicular line {{short description, None
Anatomical "lines", or "reference lines," are theoretical lines drawn through anatomical structures and are used to describe anatomical location. The following reference lines are identified in '' Terminologia Anatomica' ...
. In contrast with other pulse sites, the apical pulse site is unilateral, and measured not under an artery, but below the
heart
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
itself (more specifically, the apex of the heart). See also
apex beat
The apex is the highest point of something. The word may also refer to:
Arts and media Fictional entities
* Apex (comics), a teenaged super villainess in the Marvel Universe
* Ape-X, a super-intelligent ape in the Squadron Supreme universe
*Apex, ...
.
History
Pulse rate was first measured by ancient Greek physicians and scientists. The first person to measure the heart beat was Herophilus of Alexandria,
Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
(c. 335–280 BC) who designed a water clock to time the pulse. Rumi has mentioned in a poem that "The wise physician measured the patient's pulse and became aware of his condition." It shows the practice was common during Rumi's era and geography.
The first person to accurately measure the pulse rate was
Santorio Santorii
Santorio Santori (29 March, 1561 – 25 February, 1636) also called Santorio Santorio, Santorio de' Sanctoriis, or Sanctorius of Padua and various combinations of these names, was an Italian physiologist, physician, and professor, who introduce ...
who invented the ''pulsilogium'', a form of
pendulum
A pendulum is a weight suspended from a pivot so that it can swing freely. When a pendulum is displaced sideways from its resting, equilibrium position, it is subject to a restoring force due to gravity that will accelerate it back toward the ...
which was later studied by
Galileo Galilei
Galileo di Vincenzo Bonaiuti de' Galilei (15 February 1564 – 8 January 1642) was an Italian astronomer, physicist and engineer, sometimes described as a polymath. Commonly referred to as Galileo, his name was pronounced (, ). He was ...
. A century later another physician, de Lacroix, used the pulsilogium to test cardiac function.
See also
*
Heart rate
Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
*
Pulse meter
A heart rate monitor (HRM) is a personal monitoring device that allows one to measure/display heart rate in real time or record the heart rate for later study. It is largely used to gather heart rate data while performing various types of phy ...
*
Tempo
In musical terminology, tempo (Italian, 'time'; plural ''tempos'', or ''tempi'' from the Italian plural) is the speed or pace of a given piece. In classical music, tempo is typically indicated with an instruction at the start of a piece (often ...
*
Pulse diagnosis
Pulse diagnosis is a diagnostic technique used in Ayurveda, traditional Chinese medicine, traditional Mongolian medicine, Siddha medicine, traditional Tibetan medicine, and Unani. Although it once showed many positive results, it no longer has ...
– a practice in various types of traditional medicine