Evaluate the Characteristics of the Pulse

The carotid artery is used for the assessment of the contour and amplitude of the pulse. Contour is the shape of the wave. It is frequently described as the speed of the upward slope, downward slope, and duration of the wave. Place a hand firmly against the carotid artery until maximal force is felt. At this moment, the wave form should be discernible. The pulse may be described as normal, diminished, increased, or double-peaked. The normal carotid pulse wave is smooth, with the upward stroke steeper and more rapid than the downward stroke. A diminished pulse is a small, weak pulse. The palpating finger feels a gentle pressure rise with a distinct peak. An increased pulse is a large, strong, hyperkinetic pulse. The palpating finger feels an increased rate of rise of the ascending limb of the pulse and a brisk tap at its peak. A double-peaked pulse has a prominent percussion and tidal wave with or without a dicrotic wave. Arterial pulse abnormalities are summarized in Figure 14-24.

Type Description Cause

Anacrotic* Small, slow rising, delayed pulse Aortic stenosis with a notch or shoulder on the ascending limb

Waterhammer (Corrigan's)

Bisferiens

Alternans

Paradoxical (marked)

Rapid and sudden systolic expansion

Double-peaked pulse with a midsystolic dip

Alternating amplitude of pulse pressure

Detected by blood pressure assessment. An exaggerated drop in systolic blood pressure during inspiration

Aortic regurgitation

Aortic regurgitation

Congestive heart failure

Tamponade Constrictive pericarditis Chronic obstructive lung disease

*Also known as plateau pulse or pulsus parvus et tardus.

Normal

Anacrotic

Waterhammer

Bisferiens

Alternans

Paradoxical

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