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Measuring apex and radial pulse

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VOL: 96, ISSUE: 50, PAGE NO: 43

PHIL JEVON, RESUSCITATION TRAINING OFFICER, MANOR HOSPITAL, WALSALL

BEVERLEY EWENS, CONSULTANT NURSE, ITU;REBECCA LOWE, SISTER, CCU, MANOR HOSPITAL, WALSALL

Atrial fibrillation (AF) is a common arrhythmia that can result in a rapid, irregular heart rate. This causes an apex-radial pulse deficit, because each ventricular contraction may not be sufficiently strong to transmit an arterial pulse wave through the peripheral artery (Lip, 1993). Assessment of the radial pulse in isolation will not be an accurate reflection of the actual heart rate. Other causes for an apex-radial pulse deficit include atrial flutter.

In the absence of cardiac monitoring, the nurse assessment of the apex beat (together with the radial pulse) is an important aspect of the management of the patient with AF. A wide apex-radial pulse deficit indicates inefficient cardiac contraction.

The most common treatment for AF is digoxin, which will control the ventricular rate, particularly when AF is associated with heart failure (Jowett and Thompson, 1995). The drug’s effectiveness can be monitored by regular assessment of the apex-radial pulse deficit. The maintenance dose can usually be determined by the ventricular rate at rest. This should not be allowed to fall below 60 beats per minute except in special circumstances, for example, the concomitant administration of beta-blockers (BMA and Royal Pharmaceutical Society of Great Britain, 2000). Other treatments include amiodarone.

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