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Lifting the right wrist of the patient and palpating the pulse with your 3rd and 4th fingers is the handshake of the physical examination. Lost and forgotten or never learned, buried in the M1 text books, the peripheral pulse should be or is the physician's first encounter with his or her patient. The act of palpating the pulse, tells the physician much about the patient and the patient much about the doctor, opening and sharing the patient's and the physician's personal space in a mutually gentle and informative way.
Unfortunately, a false sense of economy and efficiency relegates this seemingly simple recording of figures to others, to the lowest level of competence. This first level of diagnostic data must not, however, be trusted to others. The same might be said of the blood pressure cuff. Hidden diagnostic nuances are lurking there behind the numbers.
The weak pulse with a slow uptake and a prolonged peak, easily suggests decreased stroke volume, volume depletion, heart failure, aortic stenosis, hypothyroid or congestive heart failure. Whilst the bounding pulse with short peak and steep sides, suggests increased volume, decreased peripheral resistance, fever, hyperthyroid, anemia, bradycardia, aortic regurgitation, patient ducts, A-V fistula or hardening of the arteries with age. The start of your differential diagnosis and knowledge of your patient lies right beneath your fingers.
Some of your differential diagnosis might be missed entirely but for the thoughtful palpation of the peripheral pulse. Bisferiens Pulse with a double peak, may be due to aortic regurgitation or regurgitation combined with stenosis or even hypertrophic cardiomyopathy. Pulsus Alterans for example, a normal beat alternating in regular interval with a weaker beat (and an S3), suggests left ventricular failure. While Bigeminal Pulse, a normal beat alternating in shorter interval with a premature contraction of weaker strength, suggests retrograde conduction etc. Intriguingly, Paradoxical Pulse, wherein pulse pressure increases more than 10 mm Hg on expiration, can lead to the early diagnosis of an unsuspected constrictive pericarditis, even tamponade or COPD. The later can be life altering for the patient and greatly enhance the career satisfaction for the physician as it did for me.
Lifting the right wrist of the patient and palpating the pulse with your 3rd and 4th fingers is the handshake of the physical examination. Lost and forgotten or never learned, buried in the M1 text books, the peripheral pulse should be or is the physician's first encounter with his or her patient. The act of palpating the pulse, tells the physician much about the patient and the patient much about the doctor, opening and sharing the patient's and the physician's personal space in a mutually gentle and informative way.
Unfortunately, a false sense of economy and efficiency relegates this seemingly simple recording of figures to others, to the lowest level of competence. This first level of diagnostic data must not, however, be trusted to others. The same might be said of the blood pressure cuff. Hidden diagnostic nuances are lurking there behind the numbers.
The weak pulse with a slow uptake and a prolonged peak, easily suggests decreased stroke volume, volume depletion, heart failure, aortic stenosis, hypothyroid or congestive heart failure. Whilst the bounding pulse with short peak and steep sides, suggests increased volume, decreased peripheral resistance, fever, hyperthyroid, anemia, bradycardia, aortic regurgitation, patient ducts, A-V fistula or hardening of the arteries with age. The start of your differential diagnosis and knowledge of your patient lies right beneath your fingers.
Some of your differential diagnosis might be missed entirely but for the thoughtful palpation of the peripheral pulse. Bisferiens Pulse with a double peak, may be due to aortic regurgitation or regurgitation combined with stenosis or even hypertrophic cardiomyopathy. Pulsus Alterans for example, a normal beat alternating in regular interval with a weaker beat (and an S3), suggests left ventricular failure. While Bigeminal Pulse, a normal beat alternating in shorter interval with a premature contraction of weaker strength, suggests retrograde conduction etc. Intriguingly, Paradoxical Pulse, wherein pulse pressure increases more than 10 mm Hg on expiration, can lead to the early diagnosis of an unsuspected constrictive pericarditis, even tamponade or COPD. The later can be life altering for the patient and greatly enhance the career satisfaction for the physician as it did for me.
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