Pulse Deficit Definition, Symptoms, Causes, Assessment, Normal Range

Learn all about pulse deficit definition, symptoms, causes, assessment and normal range of pulse. Historically, in the Middle or Far East, doctors were expected to make many diagnoses on examination of the radial pulse alone. Still today, thorough examination of the pulse can provide a lot of information and help form an accurate diagnosis. When pulse is irregular and fast, radial artery may underestimate true HR therefore use stethoscope and listen at cardiac apex.

Once the pulse rates have been obtained, the peripheral pulse rate is subtracted from the apical pulse rate. The apical pulse rate will never be lower than the peripheral pulse rate. The resulting number is the pulse deficit. Normally, the two numbers would be the same, resulting in a difference of zero. However, when there’s a difference, it’s called a pulse deficit.

The mechanism is the ventricular contractions are too weak and unable to open the aortic valve but at the same time they are good enough to close the mitral valve. To open the aortic valve it has to generate at least 60-80 mmhg pressure , while mitral valve closes even as LV generates 8-14mmhg .(LV/LA pressure cross over). So intermittently the second heart sound is missed while S1 is retained producing more heart sounds and less pulse count in the periphery. The S1 is either felt or heard at the apex but the corresponding pulse is missing. Further this intermittent absence of S2 results in totally irregular S1 /S 2 relation.

Premature heart beats such as ventricular or atrial ectopic beats and atrial fibrillation are the most common causes of apical-radial pulse deficit. When a premature beat comes so close to the preceding normal one, the peripheral pulse may feel like a single heartbeat, because the shorter the time that the heart has to fill with blood, the smaller the pulse wave may feel (shorter diastolic filling period -> lower volume). Same thing in A Fib- the stroke volumes are uneven because the heart rate is irregular and diastolic filling periods can be very short, accounting for the “missing heart beats.”

A perfect example of apical-radial pulse deficit is someone who is in ventricular bigeminy apical heart rate is twice the pulse rate.

Pulse Deficit Definition, Symptoms, Causes, Assessment, Normal Range

What is Pulse Deficit?

Pulse deficit is a clinical sign wherein, one is able to find a difference in count between heart beat (Apical beat or Heart sounds) and peripheral pulse .This occurs even as the heart is contracting, the pulse is not reaching the periphery. This can occur in few clinical situations.

Pulse Deficit Definition

Pulse deficit the difference between the apical pulse and the radial pulse, obtained by having one person count the apical pulse as heard through a stethoscope over the heart and a second person count the radial pulse at the same time.

Pulse Deficit Symptoms

Pulse deficit is symptomized sometimes by the followings;

  • fear or anxiety
  • fever
  • recent physical activity
  • pain
  • hypotension (low blood pressure)
  • blood loss
  • insufficient oxygen intake

Pulse Deficit Causes

Pulse deficit causes include any condition that reduces stroke volume considerably volume of blood pumped out in each beat or end-systolic pressure systole is the part of the cardiac cycle when active contraction of the ventricles is taking place; e.g. severe cardiac failure, cardiogenic shock, hypovolaemic shock due to reduced blood volume, usually following severe hemorrhage. Atrial fibrillation (AF) is a common arrhythmia that can result in a rapid, irregular heart rate. This causes an apex-radial pulse deficit, because each ventricular contraction may not be sufficiently strong to transmit an arterial pulse wave through the peripheral artery. Other causes for an apex-radial pulse deficit include atrial flutter.

Pulse Deficit Assessment

Assessment of the radial pulse in isolation will not be an accurate reflection of the actual heart rate.

  • First you should count the heart rate for one minute and then the pulse rate for next one minute (examination in two different cardiac cycles) .This is the commonly practiced method.
  • One examiner counts the heart rare and the other examiner counts the pulse rate at the same time (using single cardiac cycle) for one minute.
  • Examiner may put his stethoscope at the apex and simultaneously count the dropped beats in the pulse (using single cardiac cycle) for one minute.

Pulse Deficit Normal Range

Pulse rates vary according to the demand, as in sleeping .walking or running. Rates are normally between 60 and 120. The normal resting pulse ranges are as follows:

  • Newborn: 100–170 bpm
  • 6 months to 1 year: 90–130 bpm
  • 2 to 3 years: 80–120 bpm
  • 4 to 5 years: 70–110 bpm
  • 10 years and older: 60–100 bpm

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