Examine the arterial pulses, the heart rate and rhythm, and the amplitude and contour of the pulse wave.

Heart Rate

The radial pulse is commonly used to assess the heart rate (Fig. 1). With the pads of your index and middle fingers, compress the radial artery until a maximal pulsation is detected. If the rhythm is regular and the rate seems normal, count the rate for 30 seconds and multiply by 2. If the rate is unusually fast or slow, count for 60 seconds. The usual range of normal is 60 to 90 to 100 beats per minute.

FIGURE 1. Palpate the radial pulse.

Rhythm

Begin by palpating the radial pulse. If there are any irregularities, assess the rhythm at the apex by listening with your stethoscope. Premature beats of low amplitude may not be transmitted to the peripheral pulses, leading to underestimates of the heart rate. Is the rhythm regular or irregular? If irregular, try to identify a pattern: (1) Do early beats appear in a basically regular rhythm? (2) Does the irregularity vary consistently with respiration? (3) Is the rhythm totally irregular?

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