Absent radial pulse

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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30 Absent radial pulse

Instruction

Examine this patient’s pulses.

Salient features

History

• Past history of insertion of an arterial line for blood gases or arterial pressure

• Systemic symptoms in the past (Takayasu’s arteritis)

• Past history of cardiac surgery (Blalock–Taussig shunt)

• Cervical rib.

Examination

• Left radial pulse is weaker than the right.

• Examine all other pulses (including carotid, brachial, femoral, popliteal, posterior tibial and dorsalis pedis pulses).

• Check the BP in both the upper limbs (differences in BP between both arms of >10 mmHg systolic or 5 mmHg diastolic are abnormal).

Diagnosis

This patient has an absent radial pulse (lesion) that is caused by a previous Blalock–Taussig shunt.

Questions

In which conditions may the pulse rate in one arm differ from that in the other?

Usually, slowing of the pulse on one side occurs distal to the aneurysmal sac. Therefore, an aneurysm of the transverse or descending aortic arch causes a retardation of the left radial pulse. Also the artery feels smaller and is more easily compressed than usual. An aneurysm of the ascending aorta or common carotid artery may result in similar changes in the right radial pulse.

What are the causes of absent radial pulse?

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