arterial pulse

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ARTERIAL ARTERIAL PULSEPULSE

ARTERIAL ARTERIAL PULSEPULSE

It is the pressure wave which It is the pressure wave which travels along the walls of arteries when travels along the walls of arteries when blood is ejected from left ventricle into blood is ejected from left ventricle into aorta during systole.aorta during systole.

when this pressure wave travels when this pressure wave travels along walls of arteries along walls of arteries expansion of expansion of art. Walls art. Walls palpated as arterial pulse. palpated as arterial pulse.

The transmission of pressure pulse The transmission of pressure pulse wave is independent and much faster than wave is independent and much faster than the velocity of blood flow.the velocity of blood flow.

Normally Art. Pulse ends in arteriolesNormally Art. Pulse ends in arterioles there are no capillary pulsations .there are no capillary pulsations .

No pulsations in vein except jugular No pulsations in vein except jugular vein.vein. The amplitude of arterial pulse depends The amplitude of arterial pulse depends on pulse pressure. on pulse pressure.

Pulse pressure:Pulse pressure: It is the difference between diastolic and It is the difference between diastolic and

systolic B.P:systolic B.P:

It depends on:It depends on: Stoke volumeStoke volume Elasticity of arteriesElasticity of arteries Character of ejection of blood from Character of ejection of blood from

left venrtical. left venrtical.

Stroke volumeStroke volume

Pulse pressure is directly Pulse pressure is directly proportional to stroke volume.proportional to stroke volume.

Stroke volume is effected Stroke volume is effected by:by:

heart rate heart rate total peripheral resistance total peripheral resistance mean systemic filling pressure. mean systemic filling pressure.

HEART RATEHEART RATE

Stroke volume is decreased with Stroke volume is decreased with increased heart rate.increased heart rate.

TOTAL PERIPHERAL TOTAL PERIPHERAL RESISTANCERESISTANCE

If there is incr TPR If there is incr TPR arterioles are arterioles are constricted –> less blood flows to constricted –> less blood flows to tissues –> decreased venous return –tissues –> decreased venous return –> and stroke volume.> and stroke volume.

MEAN SYSTEMIC FILLING PRESSUREMEAN SYSTEMIC FILLING PRESSURE

Venous return is directly proportional Venous return is directly proportional to mean systemic filling pressure.to mean systemic filling pressure.

If this pressure incr –> Incr venous If this pressure incr –> Incr venous

return –> Incr Stroke volume.return –> Incr Stroke volume.

ELASTICITY OF ARTERIESELASTICITY OF ARTERIES

Pulse pressure is inversely Pulse pressure is inversely proportional to elasticity of arteries .proportional to elasticity of arteries .

In more elastic arteries pulse In more elastic arteries pulse pressure decr.pressure decr.

With age –> arteries are less elastic With age –> arteries are less elastic –> more pulse pressure.–> more pulse pressure.

CHARACTER OF EJECTION OF CHARACTER OF EJECTION OF BLOOD FROM LEFT VENTRICLE BLOOD FROM LEFT VENTRICLE INTO AORTAINTO AORTA

Sudden ejection of blood leads to Sudden ejection of blood leads to incr pulse pressure as compared to incr pulse pressure as compared to gradual ejection.gradual ejection.

Normally blood ejection is sudden Normally blood ejection is sudden with opening of semilunar valves.with opening of semilunar valves.

In aortic stenosis In aortic stenosis Slow ejection Slow ejection

decr pulse pressure. decr pulse pressure.

When blood is ejected from ventricle When blood is ejected from ventricle pressure wave is produced in the pressure wave is produced in the wall of aorta wall of aorta travels to peripheral travels to peripheral arteries.arteries.

Velocity of pressure pulse wave is Velocity of pressure pulse wave is faster than velocity of blood.faster than velocity of blood.

The velocity of pressure pulse wave The velocity of pressure pulse wave is 15 time > than velocity of blood in is 15 time > than velocity of blood in aortaaorta

It is 100 times > than velocity of It is 100 times > than velocity of blood flow in peripheral arteries.blood flow in peripheral arteries.

VELOCITY OF PRESSURE PULSE WAVE VELOCITY OF PRESSURE PULSE WAVE IN DIFF. ARTERIESIN DIFF. ARTERIES

Aorta Aorta 4m/sec4m/sec

Large arteriesLarge arteries 8m/sec8m/sec

Peripheral arteriesPeripheral arteries 16m/sec16m/sec

The velocity of pressure pulse waves The velocity of pressure pulse waves incr as it travels from aorta to incr as it travels from aorta to peripheral arteries.peripheral arteries.

The elasticity of arteries decr as we The elasticity of arteries decr as we go from Aorta to peripheral arteries.go from Aorta to peripheral arteries.

This is the reason for increased in This is the reason for increased in velocity of pressure pulse wave. velocity of pressure pulse wave.

Pulse pressure incr Pulse pressure incr the pressure the pressure wave travels from Aorta to peripheral wave travels from Aorta to peripheral arteries arteries This is because of This is because of augmentationaugmentation

AUGMENTATION OR SUMATIONAUGMENTATION OR SUMATION At the point of bifurcation of large At the point of bifurcation of large

arteries arteries incr resistance incr resistance the pressure the pressure wave is reflected back.wave is reflected back.

Two types of waves.Two types of waves.

1.1. On coming waveOn coming wave2.2. Reflected waveReflected wave

There is summation of oncoming There is summation of oncoming wave and reflected wave wave and reflected wave results into results into incr pulse pressure incr pulse pressure b/c of production b/c of production of a larger wave.of a larger wave.

These two wave do not neutralize each These two wave do not neutralize each other rather they are summated. other rather they are summated.

The cause of reflection is loss of elasticity.The cause of reflection is loss of elasticity.

Pressure pulse wave when reaches arterioles Pressure pulse wave when reaches arterioles there is damping there is damping pressure pulse ends in pressure pulse ends in arterioles arterioles no further transmission of pressure no further transmission of pressure wave into capillaries wave into capillaries

Arterioles are resistant vessels Arterioles are resistant vessels there is there is damping damping pressure wave dies pressure wave dies not transmitted not transmitted to capillaries (normally )to capillaries (normally )

In some conditions the pressure pulse In some conditions the pressure pulse wave may be transmitted to capillaries to wave may be transmitted to capillaries to produce capillary pulsation –produce capillary pulsation –

this occurs in:this occurs in:

1.1. Incr pulse pressure which is due to incr Incr pulse pressure which is due to incr stroke volume.stroke volume.

2.2. Extreme dilatation of arterioles Extreme dilatation of arterioles arterioles arterioles are dilated are dilated less damping less damping transmission transmission of pressure pulse wave to capillaries. of pressure pulse wave to capillaries.

TYPES OF ARTERIAL PULSE:TYPES OF ARTERIAL PULSE:

1.1. Aortic pulse (Central Pulse)Aortic pulse (Central Pulse)

1.1. Radial pulse (Peripheral pulse)Radial pulse (Peripheral pulse)

AORTIC PULSE(CENTRAL PULSE) AORTIC PULSE(CENTRAL PULSE) RECORDING FROM AORTARECORDING FROM AORTA

Sharp rise in pressure during systole Sharp rise in pressure during systole pressure is maintained for 0.2-0.3 pressure is maintained for 0.2-0.3 sec sec sharp incisure sharp incisure followed by a followed by a gradual fall in pressure to the gradual fall in pressure to the diastolic level.diastolic level.

Recorded at the time of closure of Recorded at the time of closure of aortic valve.aortic valve.

Ascending limb is anacrotic limb.Ascending limb is anacrotic limb. Descending limb is catacrotic limb.Descending limb is catacrotic limb.

RADIAL PULSE (PERIPHERAL RADIAL PULSE (PERIPHERAL PULSE)PULSE)

Recorded from radial artery. In Recorded from radial artery. In this pulse incisure is not this pulse incisure is not prominent.prominent.

SIGNIFICANCE OF ARTERIAL SIGNIFICANCE OF ARTERIAL PULSEPULSE

Heart rate can be determinedHeart rate can be determined Psychological satisfaction of patient.Psychological satisfaction of patient. Rate.Rate. RhythmRhythm VolumeVolume Status of vessel wallStatus of vessel wall Character of pulseCharacter of pulse

TYPES OF PULSETYPES OF PULSE

1. PULSUS DEFICIT1. PULSUS DEFICIT At apex heart rate is > as compared At apex heart rate is > as compared

to that in radial artery.to that in radial artery. This is b/cThis is b/c Few ventricular contractions are too Few ventricular contractions are too

weak to produce pulse in arterial weak to produce pulse in arterial system.system.

Extra systolesExtra systoles Atrial fibrillationAtrial fibrillation

PULSUS ALTERNANS.PULSUS ALTERNANS.

There is alternant incr or decr in There is alternant incr or decr in amplitude of pulse in successive amplitude of pulse in successive beats.beats.

Lt. ventricular Failure.Lt. ventricular Failure. Atrial fibrillationAtrial fibrillation

PULSE STRONG INPULSE STRONG IN

Large bounding pulse Large bounding pulse associated with associated with incr left ventricular stroke vol ,a wide incr left ventricular stroke vol ,a wide pulse pressure and a decr in peripheral pulse pressure and a decr in peripheral vascular resistance.vascular resistance.

It is seen inIt is seen in Anemia'sAnemia's HyperthyroidismHyperthyroidism ExerciseExercise FeverFever Pregnancy Pregnancy

PULSE REGULARLY IRREGULARPULSE REGULARLY IRREGULAR

Atrial flutterAtrial flutter

PULSE IRREGULARLY IRREGULARPULSE IRREGULARLY IRREGULAR Arial fibrillationArial fibrillation

PULSUS PARADOXUSPULSUS PARADOXUS Pulse becomes very strong & very Pulse becomes very strong & very

weak alternately in relation to weak alternately in relation to respiratory cycle.respiratory cycle.

Peripheral pulse becomes weaker or Peripheral pulse becomes weaker or disappear during inspiration.disappear during inspiration.

InspirationInspiration -- pulse is weak.pulse is weak.

Exp.Exp. - - Pulse is strong. Pulse is strong.

. .

Normally there is decr of 10mmHg in Normally there is decr of 10mmHg in syst B.P during inspiration .syst B.P during inspiration .

Fall in sys .B.P during inspiration is >10mmHg Fall in sys .B.P during inspiration is >10mmHg and pulse become weak or disappear in patient and pulse become weak or disappear in patient with with

pericardial effusionpericardial effusion airway obstruction airway obstruction superior vena cava obstructionsuperior vena cava obstruction

More negative intrathoracic pressure More negative intrathoracic pressure more blood is retained in blood vessels more blood is retained in blood vessels of lungs of lungs less returns to Lt. side of less returns to Lt. side of heart heart stroke vol decr stroke vol decr pulse is pulse is weak during inspiration .weak during inspiration .

Reverse during expiration Reverse during expiration pulse is pulse is strong.strong.

Pulses paradoxes is more inPulses paradoxes is more in Pericardial effusion Pericardial effusion constrictive pericarditis.constrictive pericarditis.

WATER HAMMER PULSE WATER HAMMER PULSE

It is also known as collapsing pulse.It is also known as collapsing pulse. In this there is rapid upstroke and an In this there is rapid upstroke and an

equally rapid down stroke. equally rapid down stroke. Aortic regurgitation.Aortic regurgitation.

PLATEAU PULSEPLATEAU PULSE

There is slow rise in pressure in There is slow rise in pressure in systole then pressure is maintained systole then pressure is maintained at lower level --- they falls gradually.at lower level --- they falls gradually.

e.g. Aortic stenosis.e.g. Aortic stenosis.

ARTERIOSCLEROSISARTERIOSCLEROSIS Incr pulse pressureIncr pulse pressure More rise in pressure during systole. More rise in pressure during systole. Rapid fall in pressure.Rapid fall in pressure.

PDA OR AORTIC REGURGITATIONPDA OR AORTIC REGURGITATION Sharp rise in systoleSharp rise in systole StaysStays Collapses immediatelyCollapses immediately