Interactive Guide to Physical Examination

Evaluating The Arterial Pulse

Often, a clinician can judge a patient's acute health status by taking baseline measurements of pulse and blood pressure. These measurements are so central to the physician's assessment that they are referred to as "vital signs".

This section will review pertinent anatomy and physical exam techniques for evaluating the patient's pulses.

Anatomy review:

View interactive module Click on the interactive icon to review pertinent features of upper extremity arterial anatomy.

Physical exam techniques:

With every cardiac contraction, the heart ejects a volume of blood into the arterial tree. The pressure wave caused by this ejection can be felt as the arterial pulse and provides invaluable clues as to the integrity and functioning of the patient's cardiovascular system.

When evaluating the arterial pulse, the examiner should evaluate the rate, rhythm, symmetry, amplitude and contour of the impulse. With turbulent blood flow there may be a palpable thrill.

View video Click on the video icon for a review of physical examination techniques used in assessment of the arterial pulse.

Lower extremity pulses:

Before palpating the lower extremity pulses, note the temperature of the feet, the color and texture of the skin in the lower extremities, hair distribution, as well as color of nail beds. Palpate both femoral arteries and dosalis pedis pulses, found just lateral to the extensor tendon of the great toe, as well as posterior tibial pulses, found just below and behind the medial malleolus of the ankle. Finding the popliteal pulse can be challenging. Have the patient bend his knee, and place the finger tips of both of your hands behind the knee so that they meet in the midline. Remember this pulse is fairly deep and therefore you may need to palpate deeply in order to feel it.