Editing Pulse (section)

==Characteristics==

===Rate===
{{Anchor|Pulse deficit}}{{Further|Heart rate}}
The rate of the pulse can be observed and measured on the outside of an artery by tactile or visual means. It is recorded as arterial beats per minute or BPM. Although the pulse and heart beat are related, they are not the same. For example, there is a delay between the onset of the heart beat and the onset of the pulse, known as the [[pulse transit time]], which varies by site. Similarly measurements of [[heart rate variability]] and pulse rate variability differ.<ref name="Yuda2020">{{cite journal |last1=Yuda |first1=Emi |last2=Yamamoto |first2=Kento |last3=Yoshida |first3=Yutaka |last4=Hayano |first4=Junichiro |title=Differences in pulse rate variability with measurement site |journal=Journal of Physiological Anthropology |date=21 February 2020 |volume=39 |issue=1 |pages=4 |doi=10.1186/s40101-020-0214-1 |pmid=32085811 |issn=1880-6791 |pmc=7035641|doi-access=free}}</ref> 

In healthy people, the pulse rate is close to the [[heart rate]], as measured by [[ECG]].<ref name="Yuda2020"/> Measuring the pulse rate is therefore a convenient way to estimate the heart rate.<ref>{{cite web|title=Pulse Rate Measurement|url=http://www.webmd.com/heart-disease/pulse-measurement|work=Healthwise|publisher=WebMD|access-date=14 March 2011|archive-date=23 July 2012|archive-url=https://web.archive.org/web/20120723104209/http://www.webmd.com/heart-disease/pulse-measurement|url-status=live}}</ref> '''Pulse deficit''' is a condition in which a person has a difference between their pulse rate and heart rate. It can be observed by simultaneous [[palpation]] at the [[radial artery]] and  [[auscultation]] using a [[stethoscope]] [[apex beat|at the PMI, near the heart apex]], for example. Typically, in people with pulse deficit, heart beats do not result in pulsations at the periphery, meaning the pulse rate is lower than the heart rate. Pulse deficit has been found to be significant in the context of [[premature ventricular contraction]]{{cn|date=June 2024}} and [[atrial fibrillation]].<ref>{{cite journal |last1=Karadavut |first1=Serhat |last2=Altintop |first2=Ismail |title=Pulse deficit in atrial fibrillation — a different perspective on rhythm or rate control strategy |journal=Kardiologia Polska |date=30 November 2021 |volume=79 |issue=11 |pages=1231–1238 |doi=10.33963/KP.a2021.0107|doi-access=free |pmid=34506629 }}</ref>

===Rhythm===
{{Listen|filename=|title=Sounds of an irregular heart beat.|description=Heart sounds of a teen with severe cardiac arrhythmia, causing her pulse to be irregular.|pos=[[wav]]}}
A normal pulse is regular in rhythm and force. An irregular pulse may be due to [[sinus arrhythmia]], [[ectopic beats]], [[atrial fibrillation]], [[Paroxysmal Atrial Tachycardia|paroxysmal atrial tachycardia]], [[atrial flutter]], [[Second-degree atrioventricular block|partial heart block]] etc. Intermittent dropping out of beats at pulse is called "intermittent pulse". Examples of ''regular'' intermittent (regularly irregular) pulse include [[pulsus bigeminus]], [[second-degree atrioventricular block]]. An example of ''irregular'' intermittent (irregularly irregular) pulse is [[atrial fibrillation]].

===Volume===
The degree of expansion displayed by artery during diastolic and systolic state is called volume. It is also known as amplitude, expansion or size of pulse.

====Hypokinetic pulse====
A weak pulse signifies narrow [[pulse pressure]]. It may be due to low [[cardiac output]] (as seen in [[Shock (circulatory)|shock]], [[congestive cardiac failure]]), [[hypovolemia]], [[valvular heart disease]] (such as [[aortic stenosis|aortic outflow tract obstruction]], [[mitral stenosis]], [[aortic arch syndrome]]) etc.

====Hyperkinetic pulse====
A bounding pulse signifies high pulse pressure. It may be due to low [[peripheral resistance]] (as seen in [[fever]], [[anemia]], [[thyrotoxicosis]], {{Interlanguage link multi|hyperkinetic heart syndrome|de|3=hyperkinetisches Herzsyndrom}}, [[Arteriovenous fistula|A-V fistula]], [[Paget's disease of bone|Paget's disease]], [[beriberi]], [[liver cirrhosis]]), increased cardiac output, increased [[stroke volume]] (as seen in anxiety, exercise, [[complete heart block]], [[aortic regurgitation]]), decreased distensibility of arterial system (as seen in [[atherosclerosis]], [[hypertension]] and [[coarctation of aorta]]).

The strength of the pulse can also be reported:<ref name="urlwww.meddean.luc.edu">{{cite web |url=http://www.meddean.luc.edu/lumen/MedEd/Medicine/pulmonar/pd/step5b.htm |title=www.meddean.luc.edu |access-date=2009-05-20 |archive-date=2008-09-07 |archive-url=https://web.archive.org/web/20080907071727/http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/step5b.htm |url-status=live }}</ref><ref name="urlVascular Surgery, University of Kansas School of Medicine">{{cite web |url=http://www.kumc.edu/vsurg/eval.htm |title=Vascular Surgery, University of Kansas School of Medicine |access-date=2009-05-20 |archive-url=https://web.archive.org/web/20090204080517/http://www.kumc.edu/vsurg/eval.htm |archive-date=2009-02-04 |url-status=dead }}</ref>
* 0 = Absent
* 1 = Barely palpable
* 2 = Easily palpable
* 3 = Full
* 4 = Aneurysmal or [[bounding pulse]]

===Force===
Also known as compressibility of pulse. It is a rough indication of [[systolic blood pressure]].

===Tension===
Determined mainly by mean arterial blood pressure; corresponds to [[diastolic blood pressure]]. A low tension pulse (pulsus mollis), the vessel is soft or impalpable between beats. In high tension pulse (pulsus durus), vessels feel rigid even between pulse beats.

===Form===
A form or contour of a pulse is palpatory estimation of [[arteriogram]]. A quickly rising and quickly falling pulse (pulsus celer) is seen in aortic regurgitation. A slow rising and slowly falling pulse (pulsus tardus) is seen in aortic stenosis.

===Equality===
Comparing pulses and different places gives valuable clinical information.

A discrepant or unequal pulse between left and right radial artery is observed in anomalous or aberrant course of artery, coarctation of aorta, [[aortitis]], [[dissecting aneurysm]], [[peripheral embolism]] etc. An unequal pulse between upper and lower extremities is seen in coarctation to aorta, aortitis, block at [[Aortic bifurcation|bifurcation of aorta]], [[dissection of aorta]], [[iatrogenic]] trauma and [[arteriosclerotic]] obstruction.

===Condition of arterial wall===
A normal artery is not palpable after flattening by [[Finger|digital]] pressure. A thick radial artery which is palpable 7.5–10&nbsp;cm up the forearm is suggestive of arteriosclerosis.

===Radio-femoral delay===
In coarctation of aorta, femoral pulse may be significantly delayed as compared to radial pulse (unless there is coexisting aortic regurgitation). The delay can also be observed in [[supravalvar aortic stenosis]].