Abnormal Finding
Rate
Bradycardia: Less than 60/min (Myxedema, heart block, raised IC tension, obstructive jaundice)
Tachycardia: Faster than 100/min. (Sinus tachycardia, PAT, atrial flutter, ventricular tach)
Rhythm
Irregular: (Sinus arrhythmia, extra systoles, atrial fib, pulses bigemini)
Alternating weak and strong pulse:
Pulses bigemini: Normal beat alternating with extra systole (Dig toxicity)
Pulses alternans: Normal beat alternating with low amplitude beat
Amplitude
Slow small sustained (Aortic stenosis)
Large bounding pulse: Water hammer pulse: (Aortic insufficiency, high output states, slow heart rates)
Double systolic peak: Bisferiens pulse (Aortic regurgitation)
Decrease in amplitude during inspiration: Paradoxical pulse Exaggerated in (Pericardiac tamponade, obstructive lung disease)
Compare
Missing or feeble on one side: (Prior cath, Takayasu's disease, subclavian steel syndrome)
Grading Pulse
4 = Normal
3 = Slightly diminished
2 = About half
1 = Barely palpable
0 = Absent