Peripheral Pulse

A peripheral pulse is the arterial pressure wave that reaches the examiner’s fingers. Its rate and rhythm reflect cardiac electrical and mechanical activity; its amplitude and contour are modified by stroke volume, arterial compliance, and any stenosis or occlusion between the heart and the palpated site. That is why asymmetry often matters more than an isolated grading label. A newly weaker left dorsalis pedis pulse compared with the right suggests a local or regional perfusion problem, whereas bilaterally weak pulses may reflect diffuse PAD, low cardiac output, or a measurement problem. An absent pulse is a finding to explain, not a diagnosis to announce. PAD must be confirmed objectively. Assess rate, rhythm, amplitude, contour, timing and symmetry. In an irregular rhythm, an apical rate that exceeds the radial rate is a pulse deficit: some ventricular contractions generate cardiac sounds but insufficient stroke volume to create a palpable peripheral wave. Atrial fibrillation is a common cause, but the deficit alone does not determine whether rate control or anticoagulation is required; correlate it with the ECG, ventricular rate, blood pressure and symptoms....