Pulses Location, Normal Pulse and Causes of Abnormal Pulse

The pulse is a palpable pressure wave in response to contractions of the heart (systole). As blood is forcefully pushed out of the heart, the elastic artery walls distend to accommodate the blood and rebounds to keep the blood flowing at pressure. This creates a pressure pulse that is easily felt on the superficial arteries of the wrist, elbow, neck, thigh, knee, ankle and foot, especially those lying against bone.

The following features of the pulse needs to be assessed in order to evaluate the functioning of the cardiovascular system.

  1. Rate
  2. Rhythm
  3. Volume
  4. Character

Normal Pulse

Normal Rate = 60 to 100 beats per minute (adults)

The pulse rate of babies and children are usually higher and may exceed 100 beats per minute even under normal circumstances. The causes of an abnormal pulse rate are discussed further under :

Normal Rhythm = Regular

An irregular pulse may occur with a sinus arrhythmia, extrasystoles (atrial, ventricular), atrial fibrillation or atrial flutter. It is seen in conditions like :

  • Hypertension (high blood pressure)
  • Myocardial infarction (heart attack)
  • Heart failure
  • Mitral valve disease
  • After general anesthesia
  • Hyperthyroidism
  • Severe infections and fever

Normal Volume

Pulse volume is representation of the stroke volume – the amount of blood the heart pushes out on each contraction. Stroke volume may be elevated (high) or diminished (low) under certain conditions. It is normal for the pulse volume to increase on expiration and decrease on inspiration. If this is exaggerated, then it is known as a pulsus paradoxus.

A high pulse volume can be physiological meaning that is not due to any disease process like during exercise, pregnancy and in hot environments. Certain diseases that may lead to a higher stroke volume includes :

  • Anemia
  • Hypertension (high blood pressure)
  • Hyperthyroidism
  • Peripheral vascular disease
  • Fever

Low pulse volume occurs in :

Character

  • A bisferiens pulse, also referred to as a double-beat pulse, is where two systolic peaks can be felt separated by palpable dip in between.
  • A collapsing pulse is a rapid peak followed by a sharp descent of the pulse.
  • A slow-rising pulse is a gradual rise and descent of the pulse.

These conditions are usually indicative of aortic stenosis and/or regurgitation.

Location of the Pulses

Radial Pulse

The radial pulse can be felt at the wrist and lies lateral to the flexor carpi radialis tendon when the palmar surface is facing upwards.

Brachial Pulse

The brachial pulse can be felt in the triangular cavity at the front of the elbow joint known as the antecubital fossa. It can be palpated medial to the biceps tendon.

Carotid Pulse

The carotid pulse can be felt in the neck near the the angle of the jaw. It can be palpated in front of the sternocleidomastoid muscle. Refer to the Carotid Artery.

Femoral Pulse

The femoral pulse can be felt in the femoral triangle, between the femoral vein and femoral nerve. Refer to the Femoral Artery.

Popliteal Pulse

The popliteal pulse can be felt deep in the politeal fossa which lies behind the knee joint (back of the knee).

Posterior Tibial Pulse

The posterior tibial pulse can be felt slightly below and behind the medial malleolus which is the protruberance often referred to as the inner ankle bone.

Dorsalis Pedis Pulse

The dorsalis pedis pulse can be felt on top of the foot in the groove between the first and second metatarsals. Sometimes it may be difficult to palpate.