Section V: Examination

Important information about the patient cardiac status is obtained by physical examination of arterial pulses. A differential diagnosis can be made by inspecting the arterial blood pressure and central/peripheral pulses.

Patient being evaluated presents with abnormal pulses on physical examination.

Listen for murmurs, rubs, gallops, location of cardiac impulse, parasternal lifts. Note timing of pulse with cardiac cycle.

SWP = Small Weak Pulse.

HKP = HypoKinetic Pulse.

DP = Delayed Pulse.

LBP = Large Bounding Pulse.

DPP = Double Peak Pulse.

PWSD = Palpable Waves: 1 in Systole, 1 in Diastole.

AAP = Alteration of Amplitude Pulse.

DPDI = Decreased Pulse or absent During Inspiration.

SULE = Slower Upstroke of Lower Extremity pulse compared to upper extremity/disparity in amplitude.

PP = Pulsus Parvus (diminished left ventricular stroke volume, narrow pulse pressure, increased peripheral vascular resistance).

HV = HypoVolemia.

LVF = Left Ventricular Failure.

RC = Restrictive Cardiomyopathy.

MS = Mitral Stenosis.

PT = Pulsus Tardus: aortic stenosis with delayed systolic peak, left ventricular obstruction.

KERKP = HypERKinetic Pulse-increased LV stroke volume, wide pulse pressure, decreased peripheral vascular resistance: AV fistulas, mitral regurgitation, aortic regurgitation, ventricular septal defect.

BWC = Bisferiens/Water hammer/Corrigan: aortic regurgitation, hypertrophic cardiomyopathy.

DICR = DICRrotic: low stroke volumes, dilated cardiomyopathy.

PALT = Pulsus ALTernans: severe impairment of LV function.

PPAR = Pulsus paradoxus: tamponade, airway obstruction, superior vena cava obstruction.

RFD = RadioFemoral Delay: coarctation of aorta.

SWP = PP

HKP = HV or LVF or RC or MS

DP = PT

LBP = HERKP

DPP = BWC

PWSD = DICR

AAP = PALT

DPDI = PPAR

SULE = RFD

The arterial pulse begins when the aortic valve opens and left ventricle contracts. There is a rapid rise called the anacrotic notch; then during isovolumic relaxation, there is a reversal of flow prior to aortic valve closure which is called the incisura.

Palpate all pulses and note for any differences between them, as well as simultaneous palpation of pulses and blood pressures on each side of the body.

Palpation of pulses can also give information about heart blocks and irregular rhythms: regular irregular pulses are seen in PAC/PVC/Atrial flutter, irregularly irregular pulses seen in atrial fibrillation or variable AV block and other heart blocks.

1. Chizner M, Harvey WP, ed. Classic Teachings in Clinical Cardiology: A Tribute to W. Proctor Harvey. Cedar Grove, NY: Laennec; 1996.

2. Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrisons Principles of Internal Medicine. 19th ...