peripheral arterial pulse

and jvp
Sweta sah
Intern jmcth
What is pulse?

Pulse is a wave of pressure change created by

ejection of the blood from heart into aotra
and blood column and arterial wall.
What are the site of peripheral arterial
pulse?
Temporal artery
Carotid artery
Brachial pulse Artery
Radial artery
Femoral Artery
Popliteal Artery
Posterior tibial Artery
Dorsalis pedis artery
 Evaluation of arterial pulse
Site
Rate
Rhythm
volume
Character

.
Temporal arterial pulse
 Palpated just in front of the Travis of the ear against zygomatic bone.
Carotid pulse
 Palpated medial to sternocleidomastoid muscle at level of upper border of
thyroid cartilage against carotid tubercle of transverse process of 6 th
cervical veterinary in carotid triangle
 Radial artery pulse
 Pulse is examined most commonly in
radial artey
 Palpated by gental Pressure of artery
against distal shaft of radius using tip of
index; middle and ring finger.
 Palpate both radial pulses simultaneously for radio radial
delay
 Palpate the radial and femoral pulse simultaneously for
radio femoral delay
Brachial pulse
Site : medial to anteriocubital fossa in elbow
Femoral pulse
 Palpate in the groin just below the inguinal ligament midway between the
AS IS and the pubic symphysis against the head of femur and tendon of
psoas major.
Popliteal pulse
 Most difficult to palpate
 Flex the knee to approx 120° with thumbs on
Patela, place your finger in the popliteal fossa
such that they meet in midline.
Posterial tibial pulse
 Press against the distal part of tibia approx
1cm behind and below the medical malleolus.
Dorsalis pedis pulse
 Plapate by pressing against the tarsal bone just
lateral to extensor tendon of great toe.
 Rate
 Expressed in beats per minute it is safe to
measures by counting the number of beats in a
period of 15 sec and multiply by 4 (if rhythm is
regular)
If rhythm is irregular than count the beat for 1 min
Normal is 60 to 100bpm
Abnormalities
Trachycardia (>100bpm)
Bradycardia (< 60bpm)
Rhythm
 It is spacing order at which successive pulse wave are felt.
 When the spacing between the wave is constant the pulse
is said to be normal.
 When it is not constant the pulse is said to be irregula
 Abnormalitis
 Irregularly regular( seen in premature contraction)
 Irregularly irregular (seen in AF)
Volume
 Degree of expansion of atrial wall during each
pulse wave
 Abnormalitis
1. Low volume pulse (a/k pulsus parvus) : seen in
AS, PS, pericardial effusion)
2. High volume pulse (a/k pulsus Magnus : seen in
thyrotoxicosis, beriberi, anemia, fever, old age,
exercise) .
Character
1. Anacrotic
2. Dicrotic
3. Water hammer / collapsing /Corrigan pulse
4. Pulsus paradoxus
5. Pulsus parvus
6. Pulsus magnus
 JVP ( jugular Venous pressure)
Fluctuations in right atrial pressure during cardiac
cycle generate a pulse that is transmitted backward
in to jugular veins.
 Best examined in good light while the patient
declines at 45°
Normal anatomy of jugular vein.
 Patient should lie comfortably and trunk is
incline by an angle 45°
 Elevate chin and slightly rotate head to left,
when neck muscle relax shine the light
tangential over the skin and see Pulsation.
 Why not sitting and supine position
preferred?
 Because in sitting position the upper level of
venous column is below the clavical.
 In supine position the venous column is above
the angle Of jaw
Position of patient
Selection of vein for examination of jvp

 Why right internal jugular vein?

 Because it is larger, in straight line to superior vanacava and has no
valves. The left in nominate vein is not straight and is more prone to
kinking and compression by dilated aorta, aneurysm etc.
 Why not external jugular vein?
 Because it is more superficial, prominent and easily visible as it can
be obstructed as it transverse the deep fascia of neck.
Measurement

Two scale method is used

Normally JVP doesn’t exceed 3-4 cm Of H2O above the
sternal angle.
Since, right atrium is approximately 5cm below the sternal
angle, the JVP corresponding 9cm of H2O = 7 mmhg
(As 1.36cm of H2O = 1mmof hg)
Method

 Stand on right side of patient and turn the patient head slightly left.
 Look across the neck from right side of patient
 Identify jugular venous pulsation by looking between the two head of
sternocleidomastoid muscle.
 Note the upper most point of pulsation.
 Measure the vertical height between the top of the venous pulsation
and sternal angle using two ruler , one lying vertical over Sternal
angle and other horizontal to the upper level of pulsation.
Normal wave of JVP
 a = atrial contraction
 C = closure of tricuspid
 X = downward descent of tricuspid with atrial filling
 V= peak pressure in right atrium just before opening of
tricuspid valve
 Y = opening of tricuspid valve followed by passive filling of
atrium.
 Abnormal wave
Gaint a wave = seen in right ventricular hypertrophy,
pulmonary stenosis
Cannon a wave = ( when right atrial contraction takes place
against a closed tricuspid valve as in complete heart block.
Absent a wave= seen in atrial fibrillation
CV wave = right ventricular failure
Prominent y wave = constrictive pericarditis
Elevated JVP conditions
 Cardiac temponade
 Cardiac failure
 Constrictive pericarditis
 Restrictive cardiomyopathy
 Pulmonary embolism
 Corpulmonale
 Ascites
 Excessive IV fluid
 SVC syndrome
Cause of JVP fall

 Shock
 Addison diasease
 Hypovolemia
He pa to jugular reflux
 Procedure
 Gentaly press over the abdomen over right
hypochondrium region (or Peri umbilical area) for 10
sec
 JVP rises transiently due to increase in venous return to
right atrium side of heart.
 In normal people the rise is < 3cm and falls down even
when pressure is continued.
 In people with positive test it take > 15sec to decrease
 Positive in congestive heart failure
 Tricuspid regurgitation
Reference

 HUTCHINSON‘S CLINICAL METHOD 24 EDITION

 MACLEOD‘S CLINICAL EXAMINATION 14 TH EDITION
 BATES‘S GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING 25 TH EDITION
 INTERNATE FOR PICTURE
THANK you!