Absent radial pulse

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?




• Aberrant radial artery or congenital anomaly (check the brachials and BP)


• Tied off at surgery or previous surgical cut-down


• Catheterization of the brachial artery with poor technique


• Following a radial artery line for monitoring of blood gases or arterial pressure


• Subclavian artery stenosis


• Blalock–Taussig shunt on that side (shunt from subclavian to pulmonary artery)


• Embolism into the radial artery (usually caused by atrial fibrillation)


• Takayasu’s arteritis (rare).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Absent radial pulse

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