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== Introduction ==
== Introduction ==
[[File:Pulse wave .jpg|thumb|269x269px]]
[[File:Pulse (Neck).png|thumb|200x200px|Figure. 1 Carotid Pulse (Neck)]]
Pulse/heart rate is the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle. The strength or amplitude of the pulse reflects the amount of blood ejected with myocardial contraction (stroke volume). Normal pulse rate range for an adult is between '''60-100 beats per minute'''. A well-trained athlete may have a resting heart rate of 40 to 60 beats per minute, according to the [https://www.heart.org/ American Heart Association] (AHA).<ref>Live Science. What is normal heart rate? Available from:  https://www.livescience.com/42081-normal-heart-rate.html (accessed 03/02/2020).</ref>  
Pulse/[[Heart Rate|heart rate]] is the wave of [[blood]] in the [[Arteries|artery]] created by contraction of the [[Left Ventricle Heart|left ventricle]] during a cardiac cycle. The strength or amplitude of the pulse reflects the amount of blood ejected with [[Muscle: Cardiac|myocardial]] contraction (stroke volume). Normal pulse rate range for an adult is between '''60-100 beats per minute'''. A well-trained athlete may have a resting heart rate of 40 to 60 beats per minute, according to the [https://www.heart.org/ American Heart Association] (AHA).<ref>Live Science. What is normal heart rate? Available from:  https://www.livescience.com/42081-normal-heart-rate.html (accessed 03/02/2020).</ref>See also [[Heart Rate|heart rate]]


== Types of Pulse rate ==
== Types of Pulse ==
* '''Peripheral pulses''' that can be felt at the periphery of the body by palpating an artery over a bony prominence. Examples are carotid, radial and popliteal pulses
# '''Peripheral Pulse'''  
* '''Apical pulses''' which is a central pulse located on the apex of the heart that is monitored using a stethoscope.<ref name=":0">Susan B, Thomas J, George D. Physical Rehabilitation Sixth edition. USA: F.A. Davis 2014.</ref>
#* an be felt at the periphery of the body by palpating an artery over a bony prominence. Examples are carotid, radial and [[Popliteal Fossa|popliteal]] pulses
# '''Apical Pulse'''  
#* Central pulse located on the apex of the heart that is monitored using a stethoscope.<ref name=":0">Susan B, Thomas J, George D. Physical Rehabilitation Sixth edition. USA: F.A. Davis 2014.</ref>


== Factors that Influence Heart Rate  ==
== Factors that Influence Heart Rate  ==
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*Exercise
*Exercise
*Medication<ref name=":0" />
*Medication<ref name=":0" />
== How to Check Pulse ==
=== Pulse site ===
* Temporal
* Carotid
* Brachial
* Radial
* Femoral
* Popliteal
* Dorsalis pedis<ref name=":0" />
It is easiest to take the pulse at the wrist. If you use the lower neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. [[File:Pulse.jpg|thumb|200x200px]]When taking your pulse:
* Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
* Begin counting the pulse when the clock's second hand is on the 12.
* Count your pulse for 60 seconds
* When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
* If unsure about your results, ask another person to count for you.


== Parameters of Pulses ==
== Parameters of Pulses ==
* Rate: Number of pulsation which could be '''Bradycardia''' (<60/minute) or '''Tachycardia''' (>100/minute)
* Rhythm: Time interval between pulse beats<ref name=":0" />


== Bradycardia ==
# '''Rate:''' Number of Beats per Minute
Reduced pulse rate
#* '''[[Bradycardia]]''' (<60/minute)
#* '''[[Tachycardia]]''' (>100/minute)
# '''Rhythm:''' Time Interval between Beats<ref name=":0" /><ref name=":1">Mangrum JM, DiMarco JP. [https://www.nejm.org/doi/full/10.1056/NEJM200003093421006 The evaluation and management of bradycardia.] New England Journal of Medicine. 2000 Mar 9;342(10):703-9.</ref>


Pulse Rate <60/min<ref>Mangrum JM, DiMarco JP. [https://www.nejm.org/doi/full/10.1056/NEJM200003093421006 The evaluation and management of bradycardia.] New England Journal of Medicine. 2000 Mar 9;342(10):703-9.</ref>
=== Normative Ranges ===
{| width="800" border="1" cellpadding="1" cellspacing="1"
|+'''Table.1''' Normal Pulse Rate Range by Age
|-
! scope="col" | Age
! scope="col" | Pulse Rate (Beats per Minute)
|-
| colspan="1" rowspan="1" | Newborn
| colspan="1" rowspan="1" | 100-180
|-
| colspan="1" rowspan="1" | Infant
| colspan="1" rowspan="1" | 80-150
|-
| colspan="1" rowspan="1" | Child 2-6 years
| colspan="1" rowspan="1" | 75-120
|-
| colspan="1" rowspan="1" |Child 6-12 years
| colspan="1" rowspan="1" |70-110
|-
| colspan="1" rowspan="1" |Adolescent-Adult
| colspan="1" rowspan="1" |60-90
|}


=== Indications of reduced pulse ===
== How to Check Pulse ==
* Infection (e.g. myocarditis)
[[File:Pulse.jpg|thumb|358x358px|alt=|'''Figure.2''' Pulse, wrist]]Measurement of the pulse is typicall take at either ecarotid arteTo measure pulse rate. Place your index and third fingers on your neck to the side of the [[Trachea and Larynx|trachea]], never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. To check your pulse at your wrist, place two fingers between the bone and the tendon over your radial artery (which is located on the thumb side of your wrist)
* Complication of heart surgery
* Hypothyroidism
* Medication
* Inflammatory diseases such as rheumatic fever<ref>Mayoclinic. Bradycardia. Available from: https://www.mayoclinic.org/diseases-conditions/bradycardia/symptoms-causes/syc-20355474 (accessed 03/02/2020).</ref>


=== Symptoms ===
When taking your pulse:
* Near-fainting or fainting (syncope)
* Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
* Dizziness or lightheadedness
* When you feel pulse, count the number of beats in 15 seconds. Multiply this number by four to calculate beats per minute.
* Fatigue
* When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
* Shortness of breath
* If unsure about your results, ask another person to count for you
* Chest pains
* Confusion or memory problems
* Easily tiring during physical activity


=== Types ===
== Physiotherapy Management ==
There are two basic types of bradycardia:
[[File:Pulse wave .jpg|thumb|225x225px|alt=|Pulse Wave]]
# '''Sick sinus syndrome''' is common in elderly but can occur at any age. It occurs when the sinus node (the heart's own pacemaker) fails and does not reliably trigger heartbeats.
The role of the rehabilitation professional is to monitor heart rate during any physical activity or exercise to ensure a safe activity level. The pulse rate should be considered when determining what level of intensity activity is appropriate for the patient and can be used to guide tretament by setting heart rate zones that are safe (light vs moderate vs heavy exercise intensity zone).<ref>ATI Physical Therapy. Target Heart Rate and Exercise Available from: https://www.atipt.com/news/target-heart-rate-and-exercise (accessed 03/02/2020).</ref><ref>Ekblom B, Kilbom Å, Soltysiak J. [https://www.tandfonline.com/doi/abs/10.3109/00365517309082468 Physical training, bradycardia, and autonomic nervous system]. Scandinavian journal of clinical and laboratory investigation. 1973 Jan 1;32(3):251-6.</ref>
# '''Heart block i'''s the interruption of the electrical impulses on their way to the ventricles and results in a slow. It can be partial or complete.


=== Risk factors ===
See also [[Physical Activity and Exercise Prescription|Physical Activity and Exercise PrescriptiAn]]
* Age
* High blood pressure
* Smoking
* Heavy alcohol use
* Recreational drug use
* Psychological stress or anxiety
 
=== Complications ===
* Frequent fainting spells
* Heart failure
* Sudden cardiac arrest or sudden death
 
=== Prevention ===
* Exercise
* Eat healthy diet
* Maintain healthy weight
* Don't smoke
* Avoid alcohol consumption.
* Keep blood pressure and cholesterol under control
* Manage stress
* Scheduled checkups
 
== Tachycardia ==
Elevated pulse rate
 
Pulse Rate >100/min
 
=== Indications of elevated pulse  ===
* Heart related conditions such as high blood pressure
* Poor blood supply to the myocardium due to coronary artery disease
* Thyroid disease (e.g. hyperthyroidism)
* Electrolyte imbalance
* Alcohol use
* Emotional stress<ref>Medtronic. About tachycardia (fast heartbeat). Available from: https://www.medtronic.com/au-en/your-health/conditions/fast-heartbeat.html  (accessed 03/02/2020).</ref>
 
=== Symptoms ===
* Shortness of breath
* Lightheadedness
* Rapid pulse rate
* Heart palpitations
* Chest pain
* Syncope
 
=== Types ===
# [[Atrial Fibrillation]]
# '''Atrial Flutter''': Heart's atria beats very fast but at a regular rate.
# '''Supraventricular Tachycardia''': Abnormal fast heartbeat that starts somewhere above ventricles.<ref>Ganz LI, Friedman PL. [https://www.nejm.org/doi/full/10.1056/NEJMcp051145 Supraventricular tachycardia. New England Journal of Medicine]. 1995 Jan 19;332(3):162-73.</ref>
# '''Ventricular Tachycardia''': Rapid heart rate that starts with abnormal electrical signals in the ventricles.
# '''Ventricular Fibrillation''': It occurs when rapid, chaotic electrical impulses cause the ventricles to quiver instead of pumping necessary blood to the body.
 
=== Risk Factors ===
* Anemia
* Diabetes
* Heart disease
* Heavy alcohol use
* Heavy caffeine use
* High blood pressure
* Overactive or underactive thyroid
* Psychological stress or anxiety
* Sleep apnea
* Smoking
* Use of stimulant drugs
 
=== Complication ===
* Blood clots that can cause a stroke or heart attack
* Heart failure
* Frequent fainting spells or unconsciousness
* Sudden death
 
=== Prevention ===
* Exercise
* Eat healthy diet
* Maintain healthy weight
* Don't smoke
* Avoid alcohol consumption.
* Keep blood pressure and cholesterol under control
* Manage stress
* Scheduled checkups
 
== Physiotherapy Management ==
The role of the physiotherapist is to monitor the heart rate during exercise, the intensity and safe exercise level. The pulse rate must be taking into account to determine the level of intensity exercise the patient can bear (light vs moderate vs heavy exercise intensity zone).<ref>ATI Physical Therapy. Target Heart Rate and Exercise Available from: https://www.atipt.com/news/target-heart-rate-and-exercise (accessed 03/02/2020).</ref><ref>Ekblom B, Kilbom Å, Soltysiak J. [https://www.tandfonline.com/doi/abs/10.3109/00365517309082468 Physical training, bradycardia, and autonomic nervous system]. Scandinavian journal of clinical and laboratory investigation. 1973 Jan 1;32(3):251-6.</ref>


== Further Reading ==
== Further Reading ==
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==References==
==References==
<references />
<references />
[[Category:Heart - Anatomy]]
[[Category:Exercise Testing]]
[[Category:Acute Care]]
[[Category:Physiology]]

Latest revision as of 12:49, 9 June 2023

Original Editor - Ayelawa Samuel Top Contributors - Ayelawa Samuel, Chelsea Mclene, Naomi O'Reilly, Lucinda hampton and Leana Louw  

Introduction[edit | edit source]

Figure. 1 Carotid Pulse (Neck)

Pulse/heart rate is the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle. The strength or amplitude of the pulse reflects the amount of blood ejected with myocardial contraction (stroke volume). Normal pulse rate range for an adult is between 60-100 beats per minute. A well-trained athlete may have a resting heart rate of 40 to 60 beats per minute, according to the American Heart Association (AHA).[1]See also heart rate

Types of Pulse[edit | edit source]

  1. Peripheral Pulse
    • an be felt at the periphery of the body by palpating an artery over a bony prominence. Examples are carotid, radial and popliteal pulses
  2. Apical Pulse
    • Central pulse located on the apex of the heart that is monitored using a stethoscope.[2]

Factors that Influence Heart Rate[edit | edit source]

  • Age
  • Sex
  • Emotions/stress
  • Exercise
  • Medication[2]

Parameters of Pulses[edit | edit source]

  1. Rate: Number of Beats per Minute
  2. Rhythm: Time Interval between Beats[2][3]

Normative Ranges[edit | edit source]

Table.1 Normal Pulse Rate Range by Age
Age Pulse Rate (Beats per Minute)
Newborn 100-180
Infant 80-150
Child 2-6 years 75-120
Child 6-12 years 70-110
Adolescent-Adult 60-90

How to Check Pulse[edit | edit source]

Figure.2 Pulse, wrist

Measurement of the pulse is typicall take at either ecarotid arteTo measure pulse rate. Place your index and third fingers on your neck to the side of the trachea, never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. To check your pulse at your wrist, place two fingers between the bone and the tendon over your radial artery (which is located on the thumb side of your wrist)

When taking your pulse:

  • Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
  • When you feel pulse, count the number of beats in 15 seconds. Multiply this number by four to calculate beats per minute.
  • When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
  • If unsure about your results, ask another person to count for you

Physiotherapy Management[edit | edit source]

Pulse Wave

The role of the rehabilitation professional is to monitor heart rate during any physical activity or exercise to ensure a safe activity level. The pulse rate should be considered when determining what level of intensity activity is appropriate for the patient and can be used to guide tretament by setting heart rate zones that are safe (light vs moderate vs heavy exercise intensity zone).[4][5]

See also Physical Activity and Exercise PrescriptiAn

Further Reading[edit | edit source]

References[edit | edit source]

  1. ↑ Live Science. What is normal heart rate? Available from: https://www.livescience.com/42081-normal-heart-rate.html (accessed 03/02/2020).
  2. ↑ 2.0 2.1 2.2 Susan B, Thomas J, George D. Physical Rehabilitation Sixth edition. USA: F.A. Davis 2014.
  3. ↑ Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. New England Journal of Medicine. 2000 Mar 9;342(10):703-9.
  4. ↑ ATI Physical Therapy. Target Heart Rate and Exercise Available from: https://www.atipt.com/news/target-heart-rate-and-exercise (accessed 03/02/2020).
  5. ↑ Ekblom B, Kilbom Å, Soltysiak J. Physical training, bradycardia, and autonomic nervous system. Scandinavian journal of clinical and laboratory investigation. 1973 Jan 1;32(3):251-6.
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