(pŭls )

[L. pulsus, beating]

1. The rate, rhythm, condition of arterial walls, compressibility and tension, and size and shape of the fluid wave of blood traveling through the arteries as a result of each heartbeat.
2. Rhythmical throbbing.
3. Throbbing caused by the regular contraction and alternate expansion of an artery as the wave of blood passes through the vessel; the periodic thrust felt over arteries in time with the heartbeat.

A tracing of a pulse is called a sphygmogram. It consists of a series of waves in which the upstroke is called the anacrotic limb, and the downstroke (on which is normally seen the dicrotic notch), the catacrotic limb.

The normal resting pulse in adults is between 60 and 100 beats per minute. The resting pulse is faster, in febrile patients, anemic or hypovolemic patients, people in shock, and patients who have taken drugs that stimulate the heart, such as theophylline, caffeine, nicotine, or cocaine. It may be slower in well-trained athletes; in patients using beta blockers, calcium channel blockers, or other agents; and during sleep or deep relaxation.

In patients complaining of chest pain, pulses should be assessed in at least two extremities, e.g., both radial arteries. A strong pulse on the right side with a weak one on the left may suggest an aortic dissection or a stenosis of the left subclavian artery. Young patients with high blood pressure should have pulses assessed simultaneously at the radial and femoral artery because a significant delay in the femoral pulse may suggest coarctation of the aorta. Patients with recent symptoms of stroke or claudication should have pulses checked at the carotid, radial, femoral, popliteal, and posterior tibial arteries to see whether any palpable evidence of arterial insufficiency exists at any of these locations. If a decreased pulse is detected, further evaluation might include ultrasonography or assessments of the ankle brachial index. Patients who are lightheaded or dizzy or who notice palpitations may have detectable premature beats or other pulse irregularities, e.g., the irregularly irregular pulse of atrial fibrillation.

abdominal pulse

A palpable pulse felt between the xiphoid process and the navel. This is produced by the pulse of the abdominal aorta.

alternating pulse

A pulse that varies from easily palpable to faintly palpable.
SYN: SEE: pulsus alternans

anacrotic pulse

A pulse showing a secondary wave on the ascending limb of the main wave.

anadicrotic pulse

A pulse wave with two small notches on the ascending portion.

apical pulse

A pulse felt or heard over the part of the chest wall that lies over the apex of the heart. In healthy people, this is roughly located at the left midclavicular line in the fourth intercostal space.
SYN: SEE: apical impulse

Video for Pulse: Apical

asymmetrical radial pulse

SEE: Unequal pulse.

basal pulse

SEE: Resting pulse.

bigeminal pulse

A pulse in which two regular beats are followed by a longer pause.
SYN: SEE: coupled pulse

bisferiens pulse

A pulse marked by two systolic peaks on the pulse waveform. It is characteristic of aortic regurgitation (with or without aortic stenosis) and hypertrophic cardiomyopathy.

bounding pulse

A pulse that reaches a higher intensity than normal, then disappears quickly.
SYN: SEE: collapsing pulse

brachial pulse

A pulse felt in the brachial artery.

brief pulse

In electroconvulsive therapy (ECT), the administration of an electrical current lasting between 0.5 and 2.0 milliseconds. It is associated with better efficacy, but more memory impairment than ultra-brief pulse ECT.

capillary pulse

Visible inflow and outflow of blood from the nailbed. It is a finding in patients with aortic regurgitation when their fingernails or toenails are gently depressed by the examiner's finger.
SYN: SEE: Quincke pulse

carotid pulse

A pulse felt in the carotid artery.

Video for Pulse: Carotid

catacrotic pulse

A pulse showing one or more secondary waves on the descending limb of the main wave.

catadicrotic pulse

A pulse wave with two small notches on the descending portion.

central pulse

A pulse recorded near the origin of the carotid or subclavian artery.

collapsing pulse

SEE: Bounding pulse.

Corrigan pulse

SEE: water-hammer pulse

coupled pulse

SEE: Bigeminal pulse.

dicrotic pulse

A pulse with a double beat, one heartbeat for two arterial pulsations, or a seemingly weak wave between the usual heartbeats. This weak wave should not be counted as a regular beat. It is indicative of low arterial tension and is noted in fevers.

dorsalis pedis pulse

A pulse felt over the dorsalis pedis artery of the foot.

Video for Pulse: Dorsalis Pedis

entoptic pulse

Intermittent subjective sensations of light that accompany the heartbeat.

femoral pulse

A pulse felt over the femoral artery.

Video for Pulse: Femoral

filiform pulse

SEE: Thready pulse.

hepatic pulse

A pulse due to expansion of veins of the liver at each ventricular contraction.

intermediate pulse

A pulse recorded in the proximal portions of the carotid, femoral, and brachial arteries.

intermittent pulse

A pulse in which occasional beats are skipped, caused by conditions such as premature atrial contractions, premature ventricular contractions, and atrial fibrillation.
SYN: SEE: irregular pulse

irregular pulse

SEE: Intermittent pulse.

irregularly irregular pulse

The erratic, unpredictable pulse present in atrial fibrillation.

jugular pulse

A venous pulse felt in the jugular vein.

monocrotic pulse

A pulse in which the sphygmogram shows a simple ascending and descending uninterrupted line and no dicrotism.

nail pulse

A visible pulsation in the capillaries under the nails.

oxygen pulse

The oxygen consumption divided by the heart rate in beats per minute. It is an indirect measure of the cardiac stroke volume.

paradoxical pulse

A decrease in the strength of the pulse (and of systolic blood pressure) during inspiration, a condition that may be esp. prominent in severe asthma, cardiac tamponade, obstructive sleep apnea, croup, and other conditions that alter pressure relationships within the chest.
SYN: SEE: Kussmaul pulse; SEE: pulsus paradoxus

pulse parvus

SEE: Pulsus parvus et tardus.

peripheral pulse

A pulse recorded in the arteries in the distal portion of the limbs, e.g. the pedal, radial or ulnar pulse.

pistol-shot pulse

A pulse resulting from rapid distention and collapse of an artery as occurs in aortic regurgitation.

plateau pulse

A pulse associated with an increase in pressure that slowly rises but is maintained.

popliteal pulse

A pulse felt over the popliteal artery.

Video for Pulse: Popliteal

Quincke pulse

SEE: capillary pulse

radial pulse

A pulse felt over the radial artery.

Video for Pulse: Radial

rapid pulse

SEE: Tachycardia.

regular pulse

A pulse felt when the force and frequency are the same, i.e., when the length of beat and number of beats per minute and the strength are the same.

respiratory pulse

Alternate dilatation and contraction of the large veins of the neck occurring simultaneously with inspiration and expiration.

resting pulse

A pulse rate obtained while an individual is at rest and calm.
SYN: SEE: basal pulse

retrosternal pulse

A venous pulse felt over the suprasternal notch.

Riegel pulse

SEE: Riegel pulse

running pulse

A weak, rapid pulse with one wave continuing into the next.

short pulse

A pulse with a short, quick systolic wave.

slow pulse

A pulse rate that is less than 60 beats per minute.

small pulse

SEE: pulsus parvus et tardus

soft pulse

A pulse that may be stopped by moderate digital compression.

tense pulse

A full but not bounding pulse.

thready pulse

A fine, scarcely perceptible pulse.
SYN: SEE: filiform pulse

tremulous pulse

A pulse in which a series of oscillations is felt with each beat.

tricrotic pulse

A pulse with three separate expansions during each heartbeat.

trigeminal pulse

A pulse with a longer or shorter interval after each three beats because the third beat is an extrasystole.

triphammer pulse

SEE: Water-hammer pulse.

undulating pulse

A pulse that seems to have several successive waves.

unequal pulse

A pulse in which beats vary in force.
SYN: SEE: asymmetrical radial pulse

vagus pulse

A slow pulse resulting from parasympathetic influence on heart rate, mediated by the vagus nerve.

venous pulse

A pulse in a vein, esp. one of the large veins near the heart, such as the internal or external jugular. Normally it is undulating and scarcely palpable. In conditions such as tricuspid regurgitation, it is pronounced.

vermicular pulse

A small, frequent pulse with a wormlike feeling.

water-hammer pulse

A pulse with a powerful upstroke and then sudden disappearance; a hallmark of aortic regurgitation.
SYN: SEE: triphammer pulse; SEE: Corrigan pulse

wiry pulse

A tense pulse that feels like a wire or firm cord.

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