[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [General exam and vital signs](https://durgical.com/en/clinical-exam/#a-general) › Arterial pulse: rate, rhythm and amplitude [Clinical exam](https://durgical.com/en/clinical-exam/) · [General exam and vital signs](https://durgical.com/en/clinical-exam/#a-general) # 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](https://durgical.com/en/anatomy/radial-artery/) · [Carotid arteries](https://durgical.com/en/anatomy/common-carotid-artery/) · [Brachial artery](https://durgical.com/en/anatomy/brachial-artery/) · [Femoral artery](https://durgical.com/en/anatomy/femoral-artery/) · [Popliteal artery](https://durgical.com/en/anatomy/popliteal-artery/) · [Dorsalis pedis artery](https://durgical.com/en/anatomy/dorsalis-pedis-artery/) · [Posterior tibial artery](https://durgical.com/en/anatomy/posterior-tibial-artery/) ## Key points - Resting adult: 60 to 100 beats per minute; tachycardia above 100 and bradycardia below 60 (athletes may run 40 to 60). - Regular pulse: count 30 seconds and double; irregular pulse: count a full minute, ideally at the apex. - Pulse deficit: the apical rate exceeds the radial rate because some beats do not reach the periphery; typical of atrial fibrillation. - Amplitude (OpenStax scale): 0 absent, 1+ weak or thready, 2+ normal, 3+ bounding; other scales run to 4+. - Never palpate both carotids at once: it can reduce blood flow to the brain. - Bounding, collapsing pulse in aortic regurgitation; fast, bounding pulse in hyperthyroidism; slow pulse in hypothyroidism. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/arterial-pulse-rate-rhythm-and-amplitude/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Radial artery](https://durgical.com/en/anatomy/radial-artery/) - [Carotid arteries](https://durgical.com/en/anatomy/common-carotid-artery/) - [Brachial artery](https://durgical.com/en/anatomy/brachial-artery/) - [Femoral artery](https://durgical.com/en/anatomy/femoral-artery/) - [Popliteal artery](https://durgical.com/en/anatomy/popliteal-artery/) - [Dorsalis pedis artery](https://durgical.com/en/anatomy/dorsalis-pedis-artery/) - [Posterior tibial artery](https://durgical.com/en/anatomy/posterior-tibial-artery/) ## Related - [Vital signs: what they are and how to record them](https://durgical.com/en/clinical-exam/vital-signs-what-they-are-and-how-to-record-them/) - [Peripheral pulses and the ankle–brachial index](https://durgical.com/en/clinical-exam/peripheral-pulses-and-the-ankle-brachial-index/) - [Abnormal pulses: paradoxus, alternans, parvus et tardus, bounding](https://durgical.com/en/clinical-exam/abnormal-pulses-paradoxus-alternans-parvus-et-tardus-bounding/) - [Blood pressure measurement](https://durgical.com/en/clinical-exam/blood-pressure-measurement/) - [Cardiac auscultation: the areas and the order](https://durgical.com/en/clinical-exam/cardiac-auscultation-the-areas-and-the-order/) ## Related conditions - [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) - [Aortic regurgitation](https://durgical.com/en/conditions/aortic-regurgitation/) - [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) - [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) 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](https://medlineplus.gov/ency/article/003399.htm) (U.S. National Library of Medicine (MedlinePlus), 2025); [7.1 Indicators of Physiologic Functioning - Fundamentals of Nursing | OpenStax](https://openstax.org/books/fundamentals-nursing/pages/7-1-indicators-of-physiologic-functioning) (OpenStax, Rice University, 2024); [Cardiovascular Examination - Cardiology - MSD Manual Professional Edition](https://www.msdmanuals.com/professional/cardiovascular-disorders/approach-to-the-cardiac-patient/cardiovascular-examination) (Merck & Co. (MSD Manual Professional Edition), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/arterial-pulse-rate-rhythm-and-amplitude/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/arterial-pulse-rate-rhythm-and-amplitude/