Doctors believe that taking the apical pulse (the pulse site over the apex of the heart), rather than the radial pulse, is the most accurate, non-invasive way of assessing cardiac health.
The apical pulse provides information on the heart's count, rhythm, strength, and quality.
- Many studies have suggested that radial pulse may be accurate as well if taken properly. A 30-second counting interval may be the most accurate and efficient, and a 15-second counting interval should not be used for rates faster than 100 beats per minute (bpm).
- The apical pulse is usually measured with a stethoscope placed over the heart, whereas the radial pulse is usually measured by applying finger pressure to the inner wrist and counting the number of heartbeats. They are the most used methods of checking a pulse.
- The apical pulse determines the properties of a pulse. The healthcare provider listens to specific heart functions with a stethoscope directly, which helps produce an accurate result.
Both techniques can determine the heart rate, strength, and presence of any irregularities in the pulse.
The National Institutes of Health recommends the following healthy pulse rate guidelines:
| Age group | Healthy pulse rate |
|---|---|
| Newborns up to one-month-old | 70 to 190 bpm |
| Infants 1 to 11 months old | 80 to 160 bpm |
| Children one to two years old | 80 to 130 bpm |
| Children three to four years old | 80 to 120 bpm |
| Children five to six years old | 75 to 115 bpm |
| Children seven to nine years old | 70 to 110 bpm |
| Children 10 years and older and adults (including seniors) | 60 to 100 bpm |
| Well-trained athletes | 40 to 60 bpm |
What are the common causes of abnormal pulse?
The heart rate may temporarily increase due to nervousness, anger, stress, dehydration, or overexertion. Sit down, drink water, and take slow, deep breaths to lower the heart rate. Stick to healthy lifestyle habits to lower the heart rate over time.
12 common causes for an elevated pulse rate or tachycardia
- Cardiovascular disease, high cholesterol, or diabetes
- Heart-related conditions, such as high blood pressure
- Poor blood supply to the myocardium due to coronary artery disease
- Thyroid disease (e.g., hyperthyroidism)
- Electrolyte imbalance
- Smoking and alcohol use
- Emotional stress
- Obesity or overweight
- Body’s temperature
- Dehydration
- Caffeine, drugs, and nutritional and herbal supplements
- Medications, such as thyroid medications may increase heart rate
6 common causes for a low pulse rate or bradycardia
- Infection (e.g., myocarditis)
- Complications of heart surgery
- Hypothyroidism
- Medications, such as beta-blockers
- Inflammatory diseases, such as rheumatic fever
- Bradycardia is normal in athletes
It is critical to monitor the heart rate, which is a reliable indicator of the level of fitness and overall health. It is simple to determine using fingers or a smartwatch.
If a person is concerned that their heart rate is not normal, they must consult a medical professional. If the heart rate is less than 50 beats per minute or more than 100 beats per minute, see a doctor for a proper health checkup.
What are vital signs?
Vital signs can both reveal sudden changes in a patient's condition and measure changes that occur gradually over time.
The difference between a patient's normal baseline vital signs and their current vital signs may indicate that intervention is required. The temperature, pulse, blood pressure, and respiratory rate are all vital signs.
Temperature
The human body temperature is normally in the range of 97°F to 99°F. The temperature may be measured orally, axially, rectally, over the forehead, or in the ear canal.
- Oral temperature: Place the thermometer under the tongue in the patient's mouth and instruct them to keep their mouth closed. Keep the thermometer in place for as long as the device's manufacturer recommends.
- Axillary temperature: Typically, the results are 33.8°F lower than the oral temperature. Place the thermometer in the patient's armpit and leave it there for the duration specified by the device manufacturer.
- Tympanic membrane (ear) temperature: The results are 32.54 to 33.08°F higher than an oral temperature. Do not force the thermometer into the ear or obstruct the ear canal.
- Rectal temperature: Usually, the results are 33.8°F higher than the oral temperature. Use only during unavoidable situations.
Pulse
The normal resting heart rate is 60 to 100 beats per minute. The pulse could be taken at various sites over the body, such as:
- Radial pulse: Gently palpate the radial pulse at the inner lateral wrist with the pads of the first three fingers for accurate readings.
- Apical pulse: Recommended when the pulse rate is irregular and is taken as part of a focused cardiovascular assessment. In several cardiac drugs, the apical heart rate should be considered as a measure (e.g., digoxin). The apical pulse rate, which is positioned in the fifth intercostal space in line with the middle of the clavicle in adults, should be taken for a full minute for accuracy.
- Carotid pulse: When the radial pulse is absent or difficult to palpate, this pulse may be measured just below the angle of the jaw.
Respiration rate
The normal resting respiratory rate is 10 to 20 breaths per minute.
Unobtrusively count respiratory rate while taking the pulse rate so that the patient is unaware that their respiratory rate is counted. If irregular, count for another 30 seconds or a full minute.
Blood pressure (BP)
The average BP for an adult is about 120/80 mmHg, but variations are normal for various reasons.
- The cuff is wrapped around the upper arm by the doctor while the patient holds it out to the level of their heart.
- The pump is used by the doctor to tighten the cuff around the patient’s arm, which restricts blood flow for a few seconds.
- The doctor relieves the pressure and measures the pulse rate with a stethoscope.
- When the blood begins to flow back to the arms, the doctor records the pressure on the dial. They take two measurements to determine the blood pressure.
- Nowadays, one can check their blood pressure at home using a digital display and a BP calculator to determine whether it is high, low, or normal.
Oxygen saturation (SpO2)
A healthy patient will have a SpO2 of greater than or equal to 97 percent. The SpO2 measures the percentage of oxygen saturation in the tissues. A pulse oximeter sensor attached to a patient's finger, toe (infants), or earlobe measures hemoglobin light absorption and represents arterial SpO2.
A variety of factors can have an impact on vital signs. It can change as a result of age, time, gender, medication, or the environment.
Hollerbach AD, Sneed NV. Accuracy of radial pulse assessment by length of counting interval. Heart Lung. 1990 May;19(3):258-64. https://pubmed.ncbi.nlm.nih.gov/2341264/#
Difference Between. Difference between apical and radial pulse. http://www.differencebetween.net/science/health/difference-between-apical-and-radial-pulse/
Johns Hopkins Medicine. Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure). https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure
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