Arterial and Venous Pulse Key guiding questions:
- What is an arterial pulse and what causes it?
- How does the closure of semilunar valves affect the arterial pulse?
- What is a venous pulse and why is it mainly considered on the right side of the heart?
- What are the different waves observed in jugular venous pulse and what do they indicate?
- The rhythmic palpable expansion of the arterial wall due to transmission of pressure waves along the walls of the arteries that are produced during each systole of the heart.
- The rate at which the wave travels, which is independent of and much higher than the velocity of blood flow:
- 4 m/s in the aorta
- 8 m/s in the large arteries
- 16 m/s in the small arteries of young adults
- Consequently, the pulse is felt in the radial artery at the wrist about 0.1 s after the peak of systolic ejection into the aorta.
- With advancing age, the arteries become more rigid, and the pulse wave moves faster.
Arterial pulse wave form (in Aorta = Central arterial pulse)
- Percussion wave: due to ejection of blood during ventricular systole.
- Tidal wave: wave reflected from upper part of the body
- Dicrotic notch: represents closure of aortIc valve.
- Dicrotic wave: due to rebound of blood against the closed aortic valve during diastole (reflected from lower part of the body often recorded but not palpable )
- Clinically, radial pulse is examined for the assessment of arterial pulse.
- An important and essential part of the clinical examination of a patient as pulse is one of the vital signs of a
- Provides valuable information regarding the functioning of the heart, condition of hemodynamic, such as blood pressure, and the condition of blood vessels.
- The pulse is weak (“thready”) in shock.
- Strong when stroke volume is large (during exercise)
- The pulse in aortic insufficiency is called a collapsing, Corrigan, or water-hammer pulse.
Jugular Venous Pulse
- The atrial pressure changes are transmitted to the great veins, producing characteristic waves in the record of jugular pressure:
- “A” wave: atrial contraction (ABSENT in atrial fibrillation)
- “C” wave: ventricular contraction (tricuspid bulges).
- “X” descent: atrial relaxation
- “V” wave: atrial venous filling (occurs at same of time of ventricular contraction)
- “Y” descent: ventricular filling (tricuspid opens)
- The jugular pulse waves are superimposed on the respiratory fluctuations in venous pressure.
- Venous pressure falls during inspiration because of the increased negative intrathoracic pressure and rises again during expiration.
MCQ’s for Aretrial & Jugular Venous Pulse