The arterial pulse in health and disease

Abstract

T here is in clinical medicine no physical sign more basic or important than the arterial pulse. From ancient times the pulse has been recognized as the most fundamental sign of life. The early physicians (as we learn from the works of Galen’) paid great attention to the character of the pulse in health and the changes which occurred in disease. To the modern physician the pulse is beginning to assume even greater importance. The pulse reflects disease of the heart and arteries-from which most patients succumb. In attempting to follow changing cardiovascular status under emergency conditions the modern physician frequently records the pulse directly through an intra-arterial catheter, and he wishes to gain as much information as possible from inspection of pulse contour. Further, he learns that the newer and most successful heart-assist devices have their desired effect on cardiac function by altering contour of the aortic pressure pulse,2 and he might wonder if subtle spontaneously occurring changes in pulse contour under disease conditions may adversely affect cardiac performance. The modern physician who turns for guidance on the pulse and its interpretation to a cardiology textbook, to a medical text, or to a text on cardiac catheterization is likely to be confused, misled, and disappointed. While importance of the pulse is undisputed and its increasing significance can hardly be denied, it is almost incredible that text books have shown virtually no change in their descriptions and explanations of arterial pressure pulse contour over the last seventy years. When one compares the latest editions of the most authoritative American and English cardiology textbook.? with Broadbent’s’ and Mackenzie’s+ books on the pulse, published in 1890 and 1902, respectively, (before introduction and clinical acceptance of the sphygmomanometer) one finds little advance of significance. This failure of progress is hardly due to the field being fully and adequately covered at the turn of the century and is not due to lack of headway in subsequent years, but rather is a consequence of the complicated nature of the subject and the inability of clinicians to absorb all the advances in hemodynamics that have been achieved by workers in the paramedical sciences. This paper attempts a reassessment of the arterial pressure pulse in the light of advances which have been made since publication of Mackenzie’s classic book.6 It is proposed first to give an account of contemporary concepts of the arterial pulse as they appear in current cardiology textbooks and to point out some of the anomalies and