QS Study

Special Varieties of Pulse

Pulse is a wave produced by rhythmic expansion and elongation of the arterial wall due to pressure changes during ventricular systole and diastole. It is widely familiar as a measure of the heartbeat. It is the number of times your heart beats per minute. Normal heart rate varies from person to person. Knowing yours can be an important heart-healthy gauge.

Normal rate: 60-90/minute. A healthy pulse is between 60 and 100 beats per minute (bpm).

Average: 72/minute.

Some special varieties of pulse are-

  1. Sinus arrhythmia. The normal pulse appears at regular intervals and has a rate between 60-100 per min. There may be a mild variation in the rate between the two phases of respiration which is called sinus arrhythmia.
  2. Water-hammer pulse – Syphilis, AR, CHB, PDA etc. It is a large bounding pulse associated with an increased stroke volume of the left ventricle and decrease in the peripheral resistance, leading to a wide pulse pressure.
  3. Pulsus alternant – ALVF. Causes are left ventricular failure, toxic myocarditis, paroxysmal tachycardias. It may occur for several beats following a premature beat
  4. Pulsus paradoxus – Bronchial asthma. This is because though there is increased venous return to the right side of the heart there is relative pooling of the blood in the pulmonary vasculature as a result of lung expansion and more negative intrathoracic pressure during inspiration.
  5. Pulsus bisferiens – Aortic stenosis and Aortic Regurgitation. It is a rapidly rising, twice beating pulse where both the waves are felt during systole.
  6. Pulsus bigeminy – Digitalis toxicity. It is a coupling of the pulse waves in the pair, followed by a pause. It is seen in alternate premature beats, A.V. block, and sinoatrial block with ventricular escape