What is the term for this condition?

suzanne4, 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.

Yes, difference noted between apical and radial occurs quite often with any arrythmia, but difference between right and left radial is usually due to vacular problem, not how the heart is beating. This poster was talking about the different pulses in each arm at the same time. On a healthy person, this is quite abnormal, if this is infact true. Best bet would be to check with two dinemapps at the same time, with cuffs applied by another nurse.

Essentially a difference in perfusion but not actual heart pumping differences.

The heart does not pump differently on each side, the apical rate is the apical rate.

suzanne4, RN · Jun 25, 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.

That is caused by perfusion, the heart doesn't pump at different rates from the right to left, or the otherway. The ventricles pump at the same time...

suzanne4, RN · Jun 25, 2004

Differences in arms are perfusion problems, not conduction problems.

Big difference...................

I have worked on a heart team for years, and both ventricles pump together, not at different rates. Ask any cardiologist that........... :uhoh3:

Heart conduction doesn't change to each arm, perfusion does. Such as when a patient is having short runs of PVCs, those beats will not perfuse, so you will not be able to palpate them peripherally. With atril fib, you get poor perfusion.

TechieNurse · Jun 25, 2004

Palpitations...my best advice to you, go get checked out...EKG, Holter monitor, whatever...

"both ventricles pump together, not at different rates. Ask any cardiologist that..."

Suzanne4...just wondering about Torsades. Isn't that a condition where the ventricles don't work together? Could a self-limiting episode account for the differences in pulse & B/P? (not that I think Palpitations has this, I'm just wondering) :confused:

Havin' A Party!, ASN, RN · Jun 25, 2004

... yes, peripheral pulses can be different...

I agree.

Just last night I checked a patient's pulse on the left radial and it was relatively strong and regular. Proceeded to the right and obtained a significantly lower rate (and weaker quality).

Of course, there'e only one true heart rate (apical).

wonderbee, BSN, RN · Jun 25, 2004

Differences in arms are perfusion problems, not conduction problems.
Big difference...................
I have worked on a heart team for years, and both ventricles pump together, not at different rates. Ask any cardiologist that...........
Heart conduction doesn't change to each arm, perfusion does. Such as when a patient is having short runs of PVCs, those beats will not perfuse, so you will not be able to palpate them peripherally. With atril fib, you get poor perfusion.

Thanks Suzanne. This was a bee in my bonnet all night. I want to specialize in critical care so these issues send me running for the books. The patient who I took care of with the different peripheral pulses died of heart failure and was not perfusing well at all when I saw her as evidenced by cyanosis.

Marie_LPN, RN, LPN, RN · Jun 25, 2004

Physical isn't really over. But so far i have:

Pulsus differens, SVT, and "possible" HTN. Great. :stone

Palpitations · Jun 25, 2004

Physical isn't really over. But so far i have:
Pulsus differens, SVT, and "possible" HTN. Great. :stone

Did the doctor say how he/she is going to treat it?

Palpitations · Jun 25, 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?

suzanne4, RN · Jun 26, 2004

I agree.
Just last night I checked a patient's pulse on the left radial and it was relatively strong and regular. Proceeded to the right and obtained a significantly lower rate (and weaker quality).
Of course, there'e only one true heart rate (apical).

That is a perfusion problem, not conduction.

gwenith, BSN, RN · Jun 26, 2004

As I said before - the most logical answer is a false reading from either different intensity of beat or an irregular beat that is read at the wrong time.

Torsades is still a case of the ventricles beating "together" - the way they are wired makes beating together inevitable.

suzanne4, RN · Jun 26, 2004

Palpitations...my best advice to you, go get checked out...EKG, Holter monitor, whatever...
"both ventricles pump together, not at different rates. Ask any cardiologist that..."
Suzanne4...just wondering about Torsades. Isn't that a condition where the ventricles don't work together? Could a self-limiting episode account for the differences in pulse & B/P? (not that I think Palpitations has this, I'm just wondering)

Torsades is a prolonged QT interval. Ventricles will always work together.

For more information on it, please check out this link:

http://www.qtdrugs.org/info-center/torsades.htm