By Dr Harold Gunatillake - Health Writer
Do you remember the days when the family doctor does a house call; say when your dad is sick? He would come in, smile and ask a few questions about the history of the illness, whilst his fingers will check on the radial pulse at the wrist. He would dramatize this action by first outstretching his arm, bending at the elbow, keeping the index and mid-finger over the radial artery in the wrist with a deep concentrated expression on his face. This action impresses the family, and gives lot of confidence in the doctor. Keeping a traditional basin of water and a clean towel was customary for the doctor to wash his hands before departure.
Today, with new technology the physicians don’t bother about feeling the pulse that gives you so much of information about a cardiovascular event or most other illness, lost the art of physical examination, does a cursory one, orders some blood tests and an X ray film, and may prescribe a patent medicine to get at the local chemist.
Historically our doctors were expected to make many diagnoses on examination of the radial pulse alone. Still today, thorough examination of the pulse can provide a lot of information and help form an accurate diagnosis for most inflammatory and heart diseases.
It is reasonable for lay people themselves learn to check on their own radial pulse regularly and refine the technique, in an event you could use that experience to assess one’s own health issue.
Arterial pulse can be checked up in other areas of the body, such as on the side of the head (temporal artery pulse), brachial pulse at the elbow, and femoral pulse in the groin and so on. Such examination when required is best left to the experienced doctors, but from a lay point of view it is best to get experience in focusing on the radial pulse at the wrist. It is not a suitable pulse for describing the character of the pulsation, but can be used to assess the rate and rhythm.
It may be more difficult to feel the radial pulse if your arms are fat, but by rolling your index finger and middle finger in the wrist region across without much deep pressure may be able to feel this specific pulse.
The normal resting pulse rate, which is also the rate of the heart,would be between 60 and 80 per minute, when healthythis is a very regular beat. When the beat is more than 80, we call it rapid and may be due to so many conditions. The heart pumps over 2000 gallons of blood per day and beats 100,000 times.
With fever the pulse tends to rise (tachycardia). With all bacterial originating fevers the pulse gets rapid whilst with viral diseases the pulse rate gets slower than normal. From this knowledge alone you could suspect whether your illness in the body is bacterial or viral. Kids normally have a faster pulse rate.
However, if tachycardia is defined as a pulse rate in excess of 100 bpm and bradycardia is less than 60 bpm then between 60 and 100 bpm must be seen as normal.
Feeling a regular pulse should give a sign of relief that the heart is not strained. But if the heart beat is too rapid, it pumps less efficiently and blood flow to the rest of the body, including the heart itself is reduced. In such rapid state there is a demand for more oxygen to the heart muscles, and if not controlled with medication may lead to a heart attack (myocardial infarction).
If your pulse is excessively rapid think of what may be causing it.
Think of the medication you have been put on recently. Sometimes this could occur as a result of reaction to medication. Do you consume too much of alcohol daily. That would be a cause for your rapid pulse rate. Consumption of cocaine and other recreational drugs may cause the problem. If you don’t drink adequate volume of water daily and with electrolyte imbalance you can get a rapid pulse rate.
Your heart may not be getting sufficient blood supply and damage to the heart tissues can give a rapid pulse rate. It could be heart valve disease or failure, or may be a cardiac muscle infection (cardiomyopathy).
Check your blood pressure. With uncontrolled hypertension you get a rapid and a bouncing pulse rate.
If your thyroid gland is over-secreting the hormone that could bring about a rapid pulse rate. In such a situation your doctor will do a thyroid function test to check on your thyroid.
Smoking is another cause of rapid pulse rate. In certain lung diseases you could get a rapid pulse rate with breathlessness.
So if you feel that your radial pulse rate after recording is over 100bpm. Do not waste time; see your doctor as soon as possible.
It is important to stress that you should check your blood pressure every six months if you are over 50 years, whether the pulse rate is abnormal or not. A sure sign of progressive high blood pressure is a forceful, rapid pulse when felt at the wrist. It is called the silent killer because you do not have symptoms until the pressure reaches very high and get heart failure or a stroke or may be fatal. Most strokes are preventable if you get your BP checked regularly. Why not purchase a small size sphygmomanometer at the pharmacy and check your own BP.
This could occur in atrial fibrillation and flutter. In these situations the upper chambers of the heart are not contracting rhythmically leading to irregular pulse beat. You should see your doctor at your earliest.
Another common cause of irregular pulse rate is called congestive cardiac failure (CCF). This could occur in a situation when you neglect your heart problem going into failure and that backfires and cause congestion in your lungs. This would be accompanied with swollen legs (pitting oedema) breathlessness and wheezing. Some lay people call this ‘cardiac asthma’.
Don’t waste time; see your doctor immediately before the end-stage occurs. There is a condition called congestive cardiomyopathy. Here too the pulse rhythm is altered, and may include many other symptoms like breathlessness, dizziness, heart palpitations and so on. Cardiomyopathy is a progressive disease of the myocardium, or heart muscle. In most cases, the heart muscle becomes weakened and unable to pump blood to the rest of the body as well as it should. See your doctor immediately.
As a lay person you do not require much medical knowledge to suspect heart, lung and other inflammatory episodes, just keeping a check on your radial pulse and with any suspicion of abnormality, you should see your doctor.
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