Examination of the arterial pulse

INTRODUCTION

Assessment of the arterial pulse characteristics is an integral part of the cardiovascular examination. Carotid, radial, brachial, femoral, posterior tibial, and dorsalis pedis pulses should be routinely examined bilaterally to ascertain any differences in the pulse amplitude, contour, or upstroke. Popliteal pulses should also be examined when lower extremity arterial disease is suspected.

The carotid pulse contour is very similar to that of the central aortic pulse; a delay in the onset of the ascending limb of the carotid pulse, compared with the central aortic pulse, is only about 20 msec. Thus, examination of the carotid pulse provides the most accurate representation of changes in the central aortic pulse. The brachial arterial pulse is examined to assess the volume and consistency of the peripheral vessels.

UNEQUAL OR DELAYED PULSES

Inequality in the amplitude of the peripheral pulses may result from:

• Obstructive arterial diseases, most commonly atherosclerosis
• Aortic dissection
• Aortic aneurysm
• Takayasu disease
• Coarctation of the aorta
• Supravalvular aortic stenosis in which the right carotid, brachial, and radial pulses are larger in amplitude and volume than those on the left side because of the preferential streaming of the jet toward the innominate artery

Simultaneous palpation of the radial and femoral pulses is important to determine if there is a delay in pulse transmission. In normal adults, the upstrokes of the radial and femoral pulses normally appear simultaneously. A delay in the onset of the femoral pulse, generally associated with a diminished amplitude, suggests coarctation of the aorta. (See "Who should be evaluated for renovascular or other causes of secondary hypertension?", section on 'Coarctation of the aorta'.)