Pulse Monitoring and Heart Rate Overview

Pulse Monitoring

• A pulse is a stroke/bump of blood flow on the walls of the aorta.
• Approximately 60-70 ml of blood enters the aorta with each heart contraction (stroke volume).
• Each heartbeat creates a pulse wave that travels quickly to the ends of the arteries.
• Pulse rate equals heart rate.
• Pulse can be felt (palpated) by placing fingers over a major artery near the skin, especially if the artery runs across a bone.
• Types of pulse: peripheral and central.
• Peripheral pulse is measured in the periphery of the body.
• Central/apical pulse is located over the heart's apex.
• Pulse characteristics (rate, rhythm, volume) indicate circulatory health and heart rhythm regularity.

Heart Rate/Pulse Frequency

• Heart rate is the number of heartbeats per minute.
• Factors affecting heart rate: age, gender, physical activity, emotional state, body temperature, blood volume, medications, and pathological processes.
• After puberty, males generally have a slightly slower resting heart rate than females.
• Physical activity increases heart rate due to increased metabolic rate and oxygen/nutrient demand at the cellular level.
• Emotions (stress, fear, anxiety, excitement) trigger the sympathetic nervous system, increasing vasoconstriction and the metabolic rate, force, and rate of the heart.
• Fever increases heart rate to compensate for lower blood pressure caused by vasodilation.
• Blood volume increase (hypervolemia) or decrease (hypovolemia) can influence heart rate.
• Medical conditions (e.g., cardiac or respiratory diseases) or neurological dysfunctions can change the heart rate.

Pulse Assessment Points

• Peripheral pulse points are locations where pulses are easily felt.
• Easily accessible arteries include the temporal, carotid, brachial, radial, femoral, popliteal, dorsalis pedis.
• Central (apical) pulse location is at the apex of the heart.
• Specific locations for measuring the apical pulse for infants and children less than 2 years.
• Sites for measuring the apical/central pulse depend on the patient's age.

Pulse Measurement Methods

• Palpation: feeling the pulse in an artery.
• Auscultation: using a stethoscope to listen to the heart sounds and determine the rhythmic properties of the pulse.
• Doppler method: using an ultrasound device to detect the pulse by examining blood flow.
• Oscillometric method: using a digital blood pressure monitor to detect variations in pressure in the artery when blood flows pass.
• Blood pressure measurement methods (direct/indirect) methods include:
  • Direct: arterial catheter to measure blood pressure directly.
  • Indirect: sphygmomanometer which combines a cuff and a manometer to measure arterial pressure by palpating and listening to sounds.