ABSTRACT
Irregular pulses are usually caused by atrial fibrillation (AF), the most common dysrhythmia (see Chapter 25). Newly detected irregularities should be reported, and an ECG recorded. With AF apex-radial deficit should be measured – one person using a stethoscope to count the rate at the apex of the heart over a whole minute, while a second person counts the radial pulse over the same minute. Prescribed digoxin should only be omitted if the apex rate is below 60 bpm. Feeling pulse strength provides an indication of pulse volume (cardiac stroke volume). Most readers should have normal strength pulses and stroke volume (about 70 ml at rest), but to get used to feeling normal strength pulses, it is also advisable to ask to feel colleagues’ pulses. Strong, bounding pulses indicate stroke volumes over 100 ml, while weak, thready pulses indicate stroke volumes below 40 ml. Abnormalities should be recorded and reported.
