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Questions and Answers
What characterizes tachycardia?
Which condition is described as having weak pulses alternating with normal sinus beats?
What is the primary method used for assessing the apical pulse?
What pulse rate is classified as bradycardia?
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What best describes atrial fibrillation?
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What primarily causes the pulse in the arteries?
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Which of the following factors increases heart rate?
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What is the normal range for heart rate in adults?
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Which term describes a pulse rate below 60 beats per minute?
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What is the most commonly assessed pulse site in adults?
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Which of the following characteristics of pulse refers to its strength?
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How does age generally affect pulse rate?
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Which condition is characterized by an irregular pulse and may indicate atrial fibrillation?
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What is the pulse rate range for adolescents and adults?
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What effect does exercise have on pulse rate?
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How does temperature affect pulse rate?
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Which factor contributes to an increased pulse rate due to emotional reactions?
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What is the effect of hemorrhage on pulse rate?
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How does body position affect pulse rate?
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What term describes inappropriate time intervals between pulse beats?
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What does a 'weak pulse' indicate?
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Study Notes
Definition of Pulse
- Wave of blood forced through arteries by contraction of the left ventricle
- Waves of blood created by alternating expansion and recoil of arteries during each cardiac cycle
- Tap felt in arteries caused by waves of blood forced through it by contraction of the left ventricle
Pulse Sites
- Temporal
- Carotid
- Brachial
- Ulnar
- Radial
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis
Physiology & Regulation of Pulse
- Controlled by the cardiac centers located in the medulla of the brain stem through sympathetic or parasympathetic innervations
- Can be sped up or slowed down in response to sensory impulses from the heart
- Excessive stretch of the aortic arch by increased blood volume stimulates a reflex slowing of the heart rate through the parasympathetic nervous system
- Decreased blood volume (as in hemorrhage) stimulates an increase in heart rate
Cardiac Output
- Amount of blood pushed by the ventricles per minute
- Calculated by CO = SV x HR
- Stroke Volume: amount of blood ejected per beat (~70 ml)
- Heart Rate: 60-100 beats per minute
Characteristics of Pulse
- Rate/Frequency: number of pulsations felt per minute (60-100 bpm)
- Rhythm/Regularity: time intervals between pulse beats (abnormal rhythm is called arrhythmia or dysrhythmia and can be assessed by an EKG)
-
Volume/Amplitude/Strength: amount of blood ejected against the arterial wall with each heart contraction
- Normal pulse: full, easily palpable, not easily obliterated
- Weak pulse: difficult to palpate, easily lost during palpation
- Bounding pulse: easily palpated, difficult to obliterate
Factors Affecting Pulse Rate
-
Age: pulse rate decreases with age
- Infants (1m-1yr): 120-160 beats/min
- Toddlers: (1-3 yr): 90-140 beats/min
- Preschool (3-6 yr): 80-110 beats/min
- School age (6-12 yr): 75-100 beats/min
- Adolescents/Adults: 60-100 beats/min
- Sex: female pulse rate is slightly higher than male due to increased nervousness
- Exercise/Muscular Activity: increases pulse rate, rest and sleep decrease it
- Temperature: pulse rate increases by 10 beats/min for every degree of temperature elevation
- Stress/Emotions: fear, anger, anxiety, surprise all increase pulse rate due to sympathetic stimulation
-
Medications:
- Positive chronotropic drugs (e.g., atropine) increase pulse rate
- Negative chronotropic drugs (e.g., digoxin) decrease pulse rate
- Hemorrhage: increases sympathetic stimulation and increases pulse rate
- Position Changes: pulse rate is higher in standing or sitting than lying down
- Pulmonary Conditions: poor oxygenation due to diseases increases pulse rate
-
Disease Conditions:
- Conditions that increase pulse rate: infection, thyrotoxicosis, pulmonary embolism, anemia
- Conditions that decrease pulse rate: heart block
Pulse Deficit
- Difference between the apical and radial pulse rate
- Occurs when an inefficient heart contraction fails to transmit a pulse wave to the peripheral pulse site
Abnormalities of Pulse
- Tachycardia: abnormally elevated pulse rate (over 100 bpm in adults)
- Bradycardia: abnormally slow pulse rate (under 60 bpm in adults)
- Pulsus Bigeminus (Bigeminy): premature beat (weak) alternates with normal sinus beat (strong)
- Pulsus Trigeminus (Trigeminy): premature beat alternates with two normal sinus beats
- Ventricular Tachycardia: weak pulse (150-250 bpm) due to discharging impulses from hyperexcitable focus in the ventricles, causes palpitation
- Atrial Fibrillation: irregular pulse, very weak, causes pulse deficit and palpitation due to multiple excitable areas in the atria working independently and not coordinating, AV node and bundle of His cannot conduct high atrial excitation rates
Pulse Assessment Methods
- Palpation: use the tips of the middle three fingers on one hand to apply light pressure to the strongest pulsation
- Auscultation: use a stethoscope to auscultate the apical pulse, providing more accurate assessment for difficult or irregular pulses
Stethoscope Components
- Earpiece
- Binaural
- Tubing
- Bell
- Diaphragm
- Chest Piece
Using the Stethoscope
- Diaphragm: used for bowel, lung, and heart sounds
- Bell: used for heart and vascular sounds
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Description
Test your understanding of pulse definitions, sites, and the physiology behind cardiac output regulation. This quiz covers important concepts related to how the heart and blood vessels interact during the cardiac cycle. Explore how factors influence heart rate and blood flow in the body.
