Physical Examination

• Sinus bradycardia.
• Nodal rhythm.
• Heart block.
Rapid pulse.
• Sinus tachycardia.
• Atrial tachycardia.
• Atrial flutter.
2
2‐Rhythm:
- Regular irregularity: it is regular pulse (can feel 4 regular beats) with occasional premature beats.
- Irregular irregularity, pulse i.e completely irregular as in Atrial Fibrillation and multiple ventricular
premature contraction. To differentiate → Exercise
• A.F becomes worse.
• Premature contractions disappear.
Regular tachycardia
• Sinus tachycardia.
• Paroxysmal tachycardia.
• Artrial flutter.
Irregular tachycardia
• Atrial fibrillation.
• Atrial flutter with variable block.
• Multiple premature beats.
Regular Bradycardia
• Sinus bradycardia.
• Nodal rhythm.
• 2:1 heart block.
• Complete heart block.
Irregular Bradycardia
• Slow AF.
3‐ Force of the pulse: related to systolic blood pressure, assessed by the pressure needed to obliterate the
radial pulse.
4‐ Volume: related to pulse pressure, assessed by the degree of expansion of the radial artery at the arrival
of each pulse wave.
5‐Vessel wall: Palpate the radial artery against bone normally not felt, but it is felt in the medial sclerosis
(Monckeberg sclerosis).
6‐ Character of the pulse
Normal pulse tracing
P= percussion wave (left ventricular injection early in systole).
T= tidal wave (reflection from periphery late in systole).
D= dicrotic wave = diminished blood pressure by aortic valve closure.
N= Anacrotic notch.