Clinical exam · General exam and vital signs

Arterial pulse: rate, rhythm and amplitude !

Vital sign

How to feel and count the pulse, and what a fast, slow, irregular, weak or bounding pulse points to.

Updated 2026-11-01

See it in 3D: Radial artery · Carotid arteries · Brachial artery · Femoral artery · Popliteal artery · Dorsalis pedis artery · Posterior tibial artery

What it is

The arterial pulse is the pressure wave from each left ventricular beat, felt where an artery runs close to the skin. Rate, rhythm, amplitude, side-to-side symmetry and the feel of the vessel wall are assessed. The radial pulse is the routine site; the carotid is the one checked in an unconscious patient.

Reference values

Adult: 60 to 100 beats per minute (older adults included).
Trained athlete: may be 40 to 60 beats per minute.
Amplitude scale: 0 absent; 1+ weak; 2+ normal; 3+ bounding.

Structure

The radial artery is felt at the wrist, lateral to the flexor carpi radialis tendon, against the radius.
The carotid is felt at the anterior border of the sternocleidomastoid, at the level of the thyroid cartilage.
Brachial artery: medial arm and cubital fossa; femoral: below the inguinal ligament; popliteal: popliteal fossa with the knee flexed.
Dorsalis pedis: top of the foot, lateral to the extensor hallucis longus tendon; posterior tibial: behind the medial malleolus.

How to measure it

Patient at rest for at least five minutes, seated or lying, forearm supported.
Place the pads of the index and middle fingers on the front and outer side of the wrist, lateral to the flexor tendon, over the radial artery.
Do not use your thumb, which has its own pulse and can mislead.
Press gently until the beat is felt without obliterating it.
Count 30 seconds and double if regular; count a full minute if irregular.
Describe the rhythm (regular, regularly irregular, irregularly irregular) and the amplitude.
Compare both sides and, as needed, palpate brachial, carotid, femoral, popliteal, dorsalis pedis and posterior tibial pulses.
If irregular, auscultate the apex for one minute while someone else counts the radial pulse to work out the deficit.

What abnormal values mean

Tachycardia: fever, pain, anxiety, hypovolemia, anemia, hypoxemia, sepsis, hyperthyroidism and arrhythmias.
Bradycardia: athletes, sleep, hypothyroidism, hypothermia, atrioventricular block, drugs and raised intracranial pressure.
Irregularly irregular pulse: atrial fibrillation until proven otherwise.
Weak or thready pulse: shock, hypovolemia or low cardiac output.
Absent or asymmetric pulse: arterial obstruction (atherosclerosis, embolism, dissection).
Bounding pulse: aortic regurgitation, fever, anemia, pregnancy and hyperthyroidism.

Common errors

Counting only a few seconds of an irregular pulse: the value is inaccurate.
Using the examiner's thumb or pressing so hard the pulse disappears.
Measuring right after the patient has walked or been upset.
Relying only on the oximeter in an arrhythmia: it may miss low-amplitude beats.

Test yourself

Think of the answer, then tap the question to see it.

What is a pulse deficit and in which arrhythmia is it typical?

The difference between the apical (auscultated) and radial (palpated) rates, because some beats produce no peripheral wave; it is typical of atrial fibrillation.

Why should both carotids not be palpated at the same time?

Because it can reduce blood flow to the brain and, by stimulating the carotid sinus, cause bradycardia.

How long is an irregular pulse counted?

A full minute, preferably at the apex, because multiplying a short count gives an inaccurate value.

What kind of pulse is characteristic of aortic regurgitation?

A wide, bounding pulse that rises quickly and collapses just as quickly.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Pulse: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine (MedlinePlus), 2025); 7.1 Indicators of Physiologic Functioning - Fundamentals of Nursing | OpenStax (OpenStax, Rice University, 2024); Cardiovascular Examination - Cardiology - MSD Manual Professional Edition (Merck & Co. (MSD Manual Professional Edition), 2025).

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Representative model, for educational purposes only.