Pulse Rate

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

Introduction

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).

Types of Pulse rate

• 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
• Apical pulses which is a central pulse located on the apex of the heart that is monitored using a stethoscope.

Factors that Influence Heart Rate

• Age
• Sex
• Emotions/stress
• Exercise
• Medication

How to Check Pulse

Pulse site

• Temporal
• Carotid
• Brachial
• Radial
• Femoral
• Popliteal
• Dorsalis pedis

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.

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

• Rate: Number of pulsation which could be Bradycardia (<60/minute) or Tachycardia (>100/minute)
• Rhythm: Time interval between pulse beats

Bradycardia

Reduced pulse rate

Pulse Rate <60/min

Indications of reduced pulse

• Infection (e.g. myocarditis)
• Complication of heart surgery
• Hypothyroidism
• Medication
• Inflammatory diseases such as rheumatic fever

Symptoms

• Near-fainting or fainting (syncope)
• Dizziness or lightheadedness
• Fatigue
• Shortness of breath
• Chest pains
• Confusion or memory problems
• Easily tiring during physical activity

Types

There are two basic types of bradycardia:

1. 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.
2. Heart block is 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

• 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

Symptoms

• Shortness of breath
• Lightheadedness
• Rapid pulse rate
• Heart palpitations
• Chest pain
• Syncope

Types

1. Atrial Fibrillation
2. Atrial Flutter: Heart's atria beats very fast but at a regular rate.
3. Supraventricular Tachycardia: Abnormal fast heartbeat that starts somewhere above ventricles.
4. Ventricular Tachycardia: Rapid heart rate that starts with abnormal electrical signals in the ventricles.
5. 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).

Further Reading

• Postural Tachycardia Syndrome
• Vital Signs
• Heart Arrhythmias
• Cardiac Rehabilitation