What is the term for this condition?

leslie :-D · Jun 26, 2004

to me this is quite black and white and what suzanne states makes perfect sense; bounding or weak/thready are two types of intensity which is irrelevent to the actual rate. just because a pulse's intensity might be so weak does not mean that the pulse wasn't there; it would reflect a vascular problem and not conduction. to get your actual pulse, then apical is the way to go. so no, you would not have 2 different pulse rates on your arms but could have 2 different intensities.

Drysolong · Jun 26, 2004

I thought the above was a strange response. As a student, this entire discussion has been very helpful to me

Indy, LPN, LVN · Jun 26, 2004

Directed at MishlB:

Cardiology is confusing to me, and I've encountered patients with apical/radial deficits before, as well as patients for whom the Dynamap (electronic vital signs machine thing) either won't work or gives really alarming readings. So far the discussion has been very helpful. If you have a problem with a well-educated nurse explaining pathophysiology in a manner that makes sense.

-Indy

pickledpepperRN · Jun 26, 2004

I do have problems with low magnesium at times. Once my magnesium level was 1.2, and I was symptomatic. My symptoms were mainly cramping muscles and increased irritability. The doctor just told me to take oral magnesium for six days. My magnesium level went back up to 2.0. Later, it went back down to 1.8 (I was symptomatic then too.). They never did an EKG during these bouts.
Weird huh?

I am glad you are on Mg. Good your electrolytes were checked.

I would go back and ask for an EKG, Holter monitor, or a way to send your EKG by telephone.

It is a concern that you never had an EKG when symptomatic. Iy is likely SVT but until your rhythm is recorded when symptomatic you can't be sure.

Advocate for yourself as you would a patient.

Just one nurses thoughts.

Palpitations · Jun 26, 2004

I am glad you are on Mg. Good your electrolytes were checked.
I would go back and ask for an EKG, Holter monitor, or a way to send your EKG by telephone.
It is a concern that you never had an EKG when symptomatic. Iy is likely SVT but until your rhythm is recorded when symptomatic you can't be sure.
Advocate for yourself as you would a patient.
Just one nurses thoughts.

I'm supposed to be getting a 2D Echo done in July. I don't know if that will show a conduction problem or not. It could be done on a day when my heart rate is normal...you know what I mean? Oh well, I'll let you know what I find out.

All of the responses have been very informational. Now, I know why we have to check the apical pulse when giving Lanoxin (not the heart monitor, sat monitor, or bp monitor, or radial pulse). They all can be different. As said, the true pulse rate is the apical rate. Doesn't matter if you have two different pulses in bilateral arms. :rolleyes:

Thanks

wonderbee, BSN, RN · Jun 26, 2004

I'm so grateful to be able to come here to learn from the many experienced and in-the-know nurses like Suzanne. Keep it coming. Can I adopt you as my preceptor??? :)

dphrn · Jun 26, 2004

Okay, humor me for just a second here. I took the OP to mean is it possible to palpate a different radial pulse rate on each arm. If I am assessing a pt and get a rate of 60 on one arm and 80 on the other, I have actually palpated a significant rate (not rhythm) difference and whatever the underlying cause, further evaluation is needed.

It almost sounds like the debate is what the problem is if it occurs, not can it happen. If there is a clot in one arm and perfusion is compromised, I as the nurse won't be able to PALPATE all the heart beats peripherally in that arm, so in my assessment the radial pulse rates were different.

MishlB, a healthy debate is a good thing.

leslie :-D · Jun 26, 2004

Okay, humor me for just a second here. I took the OP to mean is it possible to palpate a different radial pulse rate on each arm. If I am assessing a pt and get a rate of 60 on one arm and 80 on the other, I have actually palpated a significant rate (not rhythm) difference and whatever the underlying cause, further evaluation is needed.
It almost sounds like the debate is what the problem is if it occurs, not can it happen. If there is a clot in one arm and perfusion is compromised, I as the nurse won't be able to PALPATE all the heart beats peripherally in that arm, so in my assessment the radial pulse rates were different.
MishlB, a healthy debate is a good thing.

yes you would palpate different rate BUT the rates are actually the same but because the intensity of the poorly perfused arm is so weak, you cannot feel it. so it is not a conduction problem, but a perfusion/vascular problem and need to be pursued. so when you get different peripheral pulse rates, the intensity is clearly lacking in one of the arms. but it is physiologically impossible for 2 arms/legs to have 2 different rates.

Chad_KY_SRNA · Jun 26, 2004

Palpitations,

It sounds to me like you need to wear the Holter Moniter for a day or two. Let us know what you do and what happens.

suzy253, RN · Jun 26, 2004

This post happens to be very informative. Suzanne has been nothing but helpful in all her posts and consistently posts useful information. I personally have learned a lot from her. She goes out of her way and uses her own time to provide timely and informative discussions, debates and other useful info.

dphrn · Jun 26, 2004

yes you would palpate different rate BUT the rates are actually the same but because the intensity of the poorly perfused arm is so weak, you cannot feel it. so it is not a conduction problem, but a perfusion/vascular problem and need to be pursued. so when you get different peripheral pulse rates, the intensity is clearly lacking in one of the arms. but it is physiologically impossible for 2 arms/legs to have 2 different rates.

I thought that is what I said. If the nurse PALPATES a significant difference in pulses, for whatever reason (conduction or perfusion), it has to be evaluated further. If the pulse is so weak the nurse cannot feel it, the rate is then different than the other arm. You can't count what you can't feel. Therefore, you have two different rates. I feel like we are talking in circles now. Thanks for reiterating.

:)

leslie :-D · Jun 26, 2004

isn't that comparable to something like 'just because you can't hear it doesn't mean it wasn't said?'