Pulse Measurement

Pulse describes the palpable pressure wave in the bloodstream caused by the heartbeat. The pulse is usually measured on arteries, but there is also a weak pulse on veins. One can use the following forms of recording/pulse measurement:

  • Pressure pulse measurement (sphygmography).
  • Flow pulse measurement
  • Volume pulse measurement

The pulse can be well palpated on the following arteries:

  • Carotid artery (carotid pulse) – palpable when the neck is stretched lateral to the thyroid cartilage.
  • Arteria axillaris – palpable under the armpit.
  • Arteria radialis – palpable at the thumb-side wrist.
  • Arteria femoralis – palpable in the groin
  • Arteria poplitea – palpable in the popliteal fossa.
  • Arteria tibialis posterior – palpable at the inner ankle.
  • Arteria dorsalis pedis – palpable on the dorsum of the foot.

The pulse measurement should be done in a sitting position after a five-minute rest period twice for 30 sec each. Subsequently, one extrapolates the value to one minute. One can examine the pulse by frequency, rhythm and quality:

Pulse rate/resting heart rate (RHF; resting pulse) in adults

The resting pulse is the pulse that occurs under resting conditions, i.e., in the absence of physical and mental stress. According to the measured pulse rate/heart rate as this divided into bradycardia, normal finding or tachycardia:

  • Bradycardia: <60 beats per minute (bpm).
    • Heart disease, unspecified
    • Hypothyroidism (underactive thyroid gland)
    • Athletes
    • Vagus stimulus
  • Norm: 60-100 beats/min
  • Tachycardia: > 100 beats/min
    • Anemia (anemia)
    • Fever
    • Heart disease, unspecified
    • Hyperthyroidism (overactive thyroid gland)
    • Physical exertion

The average resting heart rate (RHF; resting pulse) is at:

  • Fetus: 150 beats/min
  • Infant: 130 beats/min
  • Child: 100 beats/min
  • Adolescent: 85 beats/min

Other notes

  • A meta-analysis demonstrated a nonlinear relationship between resting heart rate and risk of type 2 diabetes (1.83-fold; 1.2-fold for an increase of 10 heartbeats).
  • Resting heart rate (RHF) and influence on long-term risk of venous thromboembolism (VTE): at an RHF ≥ 80/min, the risk of VTE is twice that at an RHF < 60/min.
  • Resting heart rate (RHF) is an independent predictor of all-cause mortality (all-cause mortality) and myocardial infarction (heart attack) in the general middle-aged population: individuals without heart rate-lowering medication with an RHF greater than 70 beats/min had approximately 60% increased all-cause mortality (all-cause mortality) and nearly 90% increased risk of myocardial infarction (heart attack) compared with the collective with an RHF less than 70 beats/min.
  • An increase in resting rate of 10 beats per minute leads to a 9% increase in mortality risk.
  • Influence of resting heart rate in men aged 50 years: a prospective population-based longitudinal study showed that a high high resting heart rate (>75 beats/min) at age 50 years as well as an increase in rate later in life were associated with worse cardiovascular outcome compared with stable values (all-cause mortality risk was approx. twice as high as in men with a resting heart rate below 55; CHD risk was 2.2-fold higher; each one heartbeat/min increase in heart rate was mathematically associated with a 1% higher risk of cardiovascular disease and 2% higher CHD risk).
  • It is possible that an elevated resting heart rate indicates a disturbance in sympathico-vagal balance. This is known to play a central role in the pathogenesis (disease development) of left ventricular dysfunction (left ventricular function), myocardial ischemia (reduced blood flow to the heart muscle), arrhythmias, and coronary sclerosis (coronary artery disease).

Pulse rhythm

  • Pulsus regularis – regular pulse
  • Pulsus irregularis (arrhythmia) – irregular pulse, can be divided into:
    • Respiratory arrhythmia – physiological increase in frequency during inspiration (inhalation), decreases during expiration (exhalation); normal finding, most pronounced in children and adolescents.
    • Absolute arrhythmia (Arrhythmia absoluta) – cardiac arrhythmia: pulse with perfect irregularity of the pulse without dependence on respiration; occurs, for example, atrial fibrillation (VHF): depending on the pulse rate, this is divided into:
      • Bradyarrhythmia absoluta (BAA; pulse less than 60 beats per minute).
      • Normal-frequency absolute arrhythmia (pulse 60 to 100 beats per minute).
      • Tachyarrhythmia absoluta (TAA; with a pulse over 100 beats per minute).
  • Extrasystoles – extra beats with a regular basic rhythm.
    • In unspecified heart disease or digitalis intoxication (poisoning with a drug used for heart failure (cardiac insufficiency)).

Pulse qualities

Pulse voltage

  • Pulsus durus – hard pulse (“water hammer pulse”).
  • Pulsus mollis – soft pulse

Pulse height/pulse size

  • Pulsus altus – high-amplitude pulse due to large ejection volume (large blood pressure amplitude); possibly in aortic valve regurgitation; thyrotoxicosis.
  • Pulsus parvus – low-amplitude pulse; in aortic valve / mitral valve stenosis (narrowing of the aortic valve / mitral valve).
  • Pulsus parvus et tardus – low-amplitude pulse with low slope of rise; in aortic stenosis, heart failure, circulatory collapse.

Pulse shape

Pulse quality

  • Pulsus alterans – every second beat with lower pulse height; in heart failure (cardiac insufficiency).
  • Pulsus differens – lateral difference of the pulse; in aortic aneurysm. Aortic insufficiency, unilateral radial occlusion.
  • Pulsus intermittens – suspension of individual beats, whereby the heartbeat does not correspond to a palpable pulse at, for example, the radial artery; cf. pulse difference.
  • Pulsus paradoxus (paradoxical pulse) – drop in systolic blood pressure > 10 mmHg during inspiration (inspiration), with the consequence that the pulse is markedly attenuated during inspiration; in periconstrictive pericarditis (pericarditis) or pericardial tamponade (due toconstriction of the pericardium) and in tension pneumothorax or severe asthma attack (due tocompression of the heart)

Pulse difference

  • Difference between heart rate (measured by auscultation or ECG) and peripherally measurable pulse rate; causes: