ARRHYTHMIASin which the heart contracts but
does not eject blood with the contraction, such as
with some tachycardias, may result in a disparity
between the pulse and the heart rate. The nature
of the pulse aids in diagnosis:
- An alternating pulse has a regular rhythm
though some beats are strong and others are
weak. It may suggest left HEART FAILURE.
•A bigeminal pulseis a pattern of two beats, a
strong beat then a weak beat with a long pause
after. It suggests PREMATURE VENTRICULAR CON-
TRACTIONS(PVCS).
•A bounding pulsemay be rapid and forceful. It
may indicate HYPERTENSION, FEVER, ANEMIA, or
RENAL FAILURE. A bounding pulse also may occur
following intense physical exercise, in which
case it is normal.
•A rapid pulse,also called an accelerated pulse,
indicates tachycardia (heart rate of 100 beats
per minute or faster). It may suggest an
arrhythmia, cardiovascular SHOCK, fever, HYPER-
THYROIDISM, or CORONARY ARTERY DISEASE(CAD). A
rapid pulse also may occur normally following
intense physical exercise.
•A trigeminal pulse is a pattern of two equally
strong beats then a third weak beat with a long
pause after. It may suggest CARDIOMYOPATHY.
•A water-hammer pulse is a pattern in which
there is a rapid surge of blood at the pulse point
followed by a complete collapse of the artery. It
suggests aortic regurgitation, a condition in
which the aortic valve fails to close after the left
ventricle pumps blood into the aorta, allowing
blood to flow back into the heart.The characteristics of the pulse change with fit-
ness level and age. People who exercise regularly
and people who are over age 70 tend to have
slower pulse rates than people who are sedentary
or young. The average resting pulse for an adult is
60 to 100 beats per minute. Children typically
have more rapid pulse rates. The pulse rate also
temporarily increases with fever, PAIN, and anxiety.
See alsoBLOOD PRESSURE; HEART SOUNDS; TRADI-
TIONALCHINESE MEDICINE(TCM).100 The Cardiovascular System