Manual Evaluation of Arterial Pulse

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One can get much information from palpation of the arterial pulse. Blood flow obstructions, heart rate and rhythm, amplitude, symmetry and pulse contour all reflect the actions of the heart and the patency of the vessels.

The external carotid pulse can be palpated on either side of the neck between the trachea and the anterior border of the sternomastoid muscle. Take care not to manipulate the carotid sinus (bulb), located at the level of the thyroid cartilage where the common carotid artery branches into the external and internal carotids, to prevent a vaso-vagal reflex which can result in a sudden drop in blood pressure and heart rate.

The most traditionally used pulse site is the radial artery which is located on the lateral edge of each wrist. It is easily accessible, and palpation causes no adverse side effects.

The pulse rate is measured by counting or calculating the pulsations for 60 seconds. The average rate is 75 beats per minute with a normal range of 60-90 beats per minute. The rhythm of the pulse should be regular and bilaterally equal in each wrist (i.e. right and left radial pulses.) A change in rhythm (irregularity) could indicate heart disease or a cardiac conduction system disorder. However, pulse rates often fluctuate cyclically with inspiration and expiration. Should pulse intensities be unequal bilaterally, this would indicate a possible vascular disorder on one side. The intensity of the femoral and radial pulses should also be roughly equal. Although the pulse rate is usually the same as the heart rate, a tachycardia can produce a cardiac output so low that the pulse is undetectable. The regularity or irregularity depends upon the type of cardiac disorder. Also, cardiac dysrhythmias are capable of producing some contractions that are sufficient to produce a palpable pulse wave and some that are not.

The contour of the pulse wave is normally rounded and dome-shaped. As the pulse is measured with the three finger tips, an assessment can be made of the ascending portion, the crest and the descending portion of each wave. This can help infer the etiology of an existing problem. The amplitude of a pulse wave can be graded on a scale from 0-4, where:

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