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The pulse is a throbbing sensation that is felt (palpated) over peripheral arteries or listened to (auscultated) over the apex of the heart. Characteristics of the pulse are rate, quality, rhythm and the amount of blood ejected with each heart beat — these can be used to determine the effectiveness of the heart.
Regulation of the pulse is handled by the autonomic nervous system through the sinoatrial node, or pacemaker, of the heart.
The normal pulse rate is 60 to 100 beats a minute. The rhythm, or pulsation and pause pattern, should be regular. Quality of the pulse is rated on a scale of 0 to 4, 0 being an absent pulse and 4 being a bounding pulse.
The pulse is taken by pressing a peripheral artery and counting the beats for thirty seconds then multiplying the number by two. If the pulse is not regular, it should be counted for a solid minute. There eight areas where the peripheral pulse can be felt:
- temporal, felt on the temples of the face;
- carotid, felt over the carotid arteries of the neck;
- brachial, felt in the inside of the elbow;
- radial, felt on the wrist;
- femoral, felt over the femoral artery in the hip;
- popliteal, felt behind the knee;
- posterior tibial, felt behind the inner ankle;
- dorsalis pedis, felt atop the foot.
Another option for taking the pulse is to listen directly to the heart. The apex of the heart is located between the fifth and sixth ribs to the left of the sternum (fifth intercostal space, left midclavicular line). A stethoscope is pressed to the skin over the apex and the pulse is taken for a full minute.
There are many conditions related to pulse. The two most important in regards to rate are tachycardia, or an accelerated pulse, and bradycardia, a slowed pulse. Another problem is arrhythmia, or an irregular heartbeat. All of these may be symptoms of serious illness.