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Cardiovascular system
Pulse


1)
2)
3)
4)
5)

Rate
Rhythm
Pulse pressure
Character
Radio femoral delay

1) Rate  normal = 60-100 bpm
Abnormal =<60 bradycardia
= >100 tachycardia
Bradycardia physiological causes
1) Elderly ( with increase in age SA node degeneration)
2) Sleep ( decrease adrenergic discharge)
3) Athletes (basal increase in vagal discharge, its adaptation of the
body)
pathological causes

Cardiovascular cause
1) bradyarrythmias
2) inferior wall MI (common blood supply is right coronary artery to inf
...
as well as
activity
...

3) Drugs 
o Beta blockers
o Calcium channel blockers= Non dihydropyridines i
...
= heart rate ↑ by 15-20 bpm
 For every 1°F ↑ from 98°F= heart rate
↑ by 10bpm
 Eg
...
e, relative bradycardia present
...


Tachycardia
1) Physiological causes
o Infants
o Anxiety
o Exercise ( increase demand)
2) Pathological causes
Cardiovascular causes
 Tachyarrythmias
 Anterior wall MI (adjacent to anterior wall has
sympathetic fibres which gets stimulated)
Non-cardiovascular causes
 Hyperthyroidism
 Hyperthermia
 Drugs
(calcium channel blockers =(DHPs)= reflex
tachycardia due to baroreceptor stimulation
...

Pulse deficit HR-PR=0 i
...


Eg
...


2)Rhythm  normal= regular i
...

Abnormal= physiological= normal= sinus arrhythmias
=inspiration ( no fibres stimulatedno parasympathetic stimulation ↑HR
...

1) Regulary irregular= predictable
...
Eg, side effect of digoxin
...


3)Pulse pressure also known as pulse volume
...

PP=SBP-DBP
Normal= 30-60mmHg
Abnormal=decrease PP=<30mmHg = thready pulse
=increase PP= >60mmHg =bounding pulse
1) Low PP= when SBP is low and DBP is high
SBP(↓) − DBP(↑)
...
e
...
e, by arterioles
...


Causes of bounding pulse
When SBP ↑ and DBP ↓
SBP(↑)-DBP(↓)
Etiology= ↑ CO
Compensatory ↓ of peripheral resistancethis occur to prevent early
CHFDBP ↓ (automatically)
...

 Prototype of ↑ CO and CVD
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 Anaemia  because of ↑ demand
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Eg,paget’s disease (AV fistula inside bone)
 Beri beri vit B1 deficiency peripheral vasodilation ↓PR ↑CO
...

Tidal volume

1) percussion wave= LV contracts pressure is transmitted through
aorta to carotid
...
e, brachial , radial
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4) Clinically only systolic wave felt
...

6) Abnormal characters=

1
...
e, ↑ amplitude of
tidal wave) =due to ↑cardiac output state
...
Hypokinetic = ↓ amplitude of systolic wave
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-cardiogenic shock
...
pulsus parvus et tardus= less amplitude , late peak
...

4
...

Causes= severe hypovolemia
=cardiogenic shock(severe)
5
...


6
...

No irregularity with interval
LV failure(most specific)
7
...

If this difference is >10 mmHg= pulsus paradoxus
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RV has ↑ chances of compression due to thin wall
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But if temponade is there  positive pressureit won’t
allow to expand RV
...

Hence this leads to ↓ CO of LV during inspiratory phase hence
SBP ↓pulsus paradoxus
...

There is failure of heart relaxation due to stiff pericardium
...

• Restrictive cardiomyopathy
Failure of heart relaxation due to stiff endomyocardium
...

Non-CVD causes
• Severe asthma and COPD exacerbations
There is large negative intrathoracic pressure
...

Venous return to RV is increases > normal
Extra blood causes intraventricular septum bulge into LV
• Baseline RV pressure is ↑
Hence even normal ↑ of inspiration blood volume will cause
intraventricular septum bulge
Eg, pulmonary thromboembolism
...


• Hypovolemia
...
Water hammer pulse/collapsing pulse/corrigans pulse
Seen in ↑ CO state
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5)Radio-femoral delay
After LV contractions carotid felt first followed by
brachialfemoral radial
...

Causes= coarctation of aorta (MC site distal to left SCA)
If COA proximal to LEFT SCA then radio-femoral delay positive
on right side only

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