What is the term for this condition?

kids · Jun 24, 2004

I have had patients who, during a run of A-fib have significantly different right and left radial pulses when palpated by 2 nurses at the same time.

kids · Jun 24, 2004

yes you can have a difference in bp, but yes, you can have a difference in pulse from side to side. i deal with this on a daily basis at work. also, check your taber's. it will explain it better... look under pulsus differens.

from tabers cyclopedic medical dictionary (online version)

pulsus differens a condition in which the pulses on either side of the body are of unequal intensity.
it is seen sometimes in aortic dissection, or in atherosclerotic obstruction of one of the subclavian arteries.
copyright 2001 by f. a. davis company

if the pulses of are different intensity it easily stands to reason that the number of beats for minute cwould be felt (and counted) differently between the right and left.

Palpitations · Jun 24, 2004

From Tabers Cyclopedic Medical Dictionary (Online version)
If the pulses of are different intensity it easily stands to reason that the number of beats for minute cwould be felt (and counted) differently between the right and left.

Thanks for the feedback everyone! I knew there was a term for it. I guess that I better make an appointment with the doctor!

:uhoh3:

jnette, ASN, EMT-I · Jun 24, 2004

Isn't the phenomenom called a pulse deficit? As I recall, my flowsheets have a space for bilateral pulse rates. They can indeed be different.

I believe you're right , KittyKat !

I do remember reading about this.

Altra, BSN, RN · Jun 25, 2004

I went back to my notes from first semester assessment (I needed to organize them in a binder anyway! :rolleyes: )

A pulse deficit is when there is a difference between the apical pulse and a peripheral pulse, such as the radial. It would probably indicate some vascular problem.

I'm thinking about what Suzanne said ... there is only one heart beating. From the medical encyclopedia entry it seemed to say that pulsus differens was a difference in intensity or quality of the pulse in different areas of the body, but there's still only one rate, right?

If it were me I would get any pulse deficit evaluated.

wonderbee, BSN, RN · Jun 25, 2004

I went back to my notes from first semester assessment (I needed to organize them in a binder anyway! )
A pulse deficit is when there is a difference between the apical pulse and a peripheral pulse, such as the radial. It would probably indicate some vascular problem.
I'm thinking about what Suzanne said ... there is only one heart beating. From the medical encyclopedia entry it seemed to say that pulsus differens was a difference in intensity or quality of the pulse in different areas of the body, but there's still only one rate, right?
If it were me I would get any pulse deficit evaluated.

I had a patient who was just a half hour from her death. When I felt her radial pulses bilaterally, they were different rates and rythyms. So yes, peripheral pulses can be different. When that happens, we are supposed to get another nurse to count one side, while we count the other. I believe it's from the chambers of the heart beating out of sync for lack of a better descriptive terminology. I've only completed my first semester so I could be way wrong on the reason.

NurseKratchet · Jun 25, 2004

IMO could it not be possible if the one side has a weaker palpable pulse then possible the machine is not picking up the rate even though it might be the same just in my experience if I assess a weak pulse in one arm I do try the other and when a pulse is weak you can't always feel it so if there is a difference in what is being felt by finger or machine it is something that should be looked into but I do agree with others there is only one heart rate but intensity can be different via the definition of pulsus differens and obviously can indicate a possible cardiac issue..................What do you all think?

Ruthie

CHATSDALE · Jun 25, 2004

a pulse deficient can occur radial vs apical and i guess that if your blood flow is hampered one one side it will result in different pulse rates...do you have colde fingers on one side than the other ..any tingling???

Palpitations · Jun 25, 2004

a pulse deficient can occur radial vs apical and i guess that if your blood flow is hampered one one side it will result in different pulse rates...do you have colde fingers on one side than the other ..any tingling???

I'm cold all the time. I get this weak feeling. When I get the weak feeling, I'll check my blood pressure and this difference is what I'll find. It just seems to happen when I'm feeling weak. I don't want to call the doctor about it because it doesn't happen all the time, and I don't want her thinking that I'm some sort of hypochondriac or something.

jaimealmostRN · Jun 25, 2004

Call your doctor ASAP. She is familiar (if she's a cardiologist or can refer you to one) with these types of things (deficit, differens,etc.)and will be able to order an EKG or electrophysiology tests if necessary. When it comes to cardiac stuff, I wouldn't fool around.

gwenith, BSN, RN · Jun 25, 2004

There is another explanation why an otherwise healthy person can appear to have two different pulse rates - irregular heart beat.

Some people have a very very marked sinus arrhythmia and the pulse slows significantly when they breathe in. Take your pulse while holding your breath or mostly breathing out and you will appear to have a different rate. It is a "false" reading.

A patient with atrial fibrillation can appear to have a different peripheral pulse to apical pulse because the beats of the heart are not only irregular in spacing but irregular in strength - again although you do indeed only have one heart beat (unless of course you are Dr Who or a Klingon) the different intensity of the beat will give a different reading of the pulse.

suzanne4, RN · Jun 25, 2004

From Tabers Cyclopedic Medical Dictionary (Online version)
If the pulses of are different intensity it easily stands to reason that the number of beats for minute cwould be felt (and counted) differently between the right and left.

Intensity means how strong the pulse is, not a different rate. The heart is beating one cycle then it starts again, if you are palpating something different that is usually related to a vascular problem, not from the heart.

Have you ever wathed an actual heart beating? The ventricles pump together...this is when you feel the pulse. But if the person is trying to check their own blood pressure in each arm, you usually will not get the second cuff placed exactly right. Best thing is to have another nurse check your pressures at the same time for you. Or when you are at work, you can use two separate dinemapps, but you are much better actually palpating and not relying on a machine.