Explain short
Here's a concise breakdown of the infographic on Pulse Examination & Its Waveforms:
1. Definition of Pulse
A pressure wave transmitted through arteries after left ventricular contraction. Felt at sites like the radial, carotid, brachial, femoral, popliteal, and dorsalis pedis arteries.
2. Components of Pulse Examination (RCVS mnemonic)
| Component | Details |
|---|---|
| Rate | Normal: 60–100/min; Tachy >100; Brady <60 |
| Rhythm | Regular / Regularly irregular / Irregularly irregular |
| Volume (Amplitude) | Reflects stroke volume & pulse pressure |
| Character | Shape of the waveform |
| Symmetry | Compare both sides |
| Vessel Wall | Assess arterial stiffness |
3. Normal Pulse Waveform
- Percussion wave – main systolic upstroke (ventricular ejection)
- Tidal wave – reflected wave from peripheral arteries
- Dicrotic notch – aortic valve closure
- Dicrotic wave – elastic recoil of arteries (diastole)
4. Types by Volume
- Small pulse (Pulsus parvus): Low amplitude → Shock, severe aortic stenosis, heart failure
- Bounding pulse: Large amplitude → Fever, anemia, hyperthyroidism, PDA
5. Key Pulse Characters & Waveforms
| Pulse | Feature | Seen In |
|---|---|---|
| Anacrotic | Slow upstroke, delayed peak | Severe aortic stenosis |
| Collapsing (Water Hammer) | Rapid rise & collapse, high pulse pressure | Aortic regurgitation, PDA, hyperdynamic states |
| Bisferiens | Two systolic peaks | AS + AR combined, HCM |
| Dicrotic | One systolic + one diastolic peak | Low cardiac output, sepsis, shock |
| Pulsus Alternans | Alternating strong & weak beats | Severe LV failure |
| Pulsus Paradoxus | BP drops >10 mmHg on inspiration | Cardiac tamponade, asthma, COPD, constrictive pericarditis |
| Pulsus Bigeminus | Beats in pairs (normal + premature) | Ventricular ectopics |
| Pulsus Trigeminus | Every 3rd beat premature | Ventricular ectopics |
| Pulsus Deficit | Apical rate > peripheral pulse rate | Atrial fibrillation |
6. Rhythm Abnormalities
- Regular → Normal sinus rhythm
- Regularly irregular → Bigeminy, Trigeminy
- Irregularly irregular → Atrial fibrillation
7. Clinical Pearls
- Carotid pulse best for assessing waveform character
- Radial pulse best for rate & rhythm
- Always compare both arms for asymmetry
- Weak pulse → shock; Bounding pulse → hyperdynamic state
- Irregular pulse → suspect arrhythmia
- Always assess volume + character, not just rate
Mnemonic: R-R-C-V-S
Rate → Rhythm → Character (Radio-radial delay) → Volume → Symmetry
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