Pulse Deficit

Oh yes, this can happen, but I wouldn't say it's normal. Children with congenital heart disease will have a variety of symptoms. Coartctation of the aorta for example will cause a significant pressure gradient between the upper and lower limbs, and also from arm to arm with the left arm having the highest blood pressure. Some dysrhythmias will cause a pulse deficit, especially the tachydysrhythmias. The heart will not have time to adequately fill in diastole when the rate is too high; there will be an apical pulse but there may not be enough blood flow to create a peripheral pulse with every beat. There may be other reasons for variations in pulses such as intravascular clot formation, collateral circulation that steals some of the flow from the artery you're assessing and so on. Does that make sense?