When palpating the pulse, carefully evaluate the regularity of the rhythm. The slower the rate, the longer you should palpate. If the rhythm is irregular, is there a pattern to the irregularity?
Cardiac rhythm may be described as regular, regularly irregular, or irregularly irregular. A regularly irregular rhythm is a pulse with an irregularity that occurs in a definite pattern. An irregularly irregular pulse has no pattern.
Electrocardiography is really the best medium for diagnosing the rhythm, but the physical examination may provide some clues. Premature beats may be recognized by the presence of isolated extra beats during a regular rhythm. Bigeminy is a coupled rhythm of beats in pairs. The first beat is the sinus beat, which is followed by a premature, usually ventricular, beat. If the premature beat is very early in the diastolic period, the pulse from this beat may be missed if the examiner evaluates the rhythm by palpation alone. A rhythm that is grossly irregular with no pattern is irregularly irregular and is the pulse in patients with atrial fibrillation.
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