Pulse, bounding

Produced by large waves of pressure as blood ejects from the left ventriclewith each contraction, a bounding pulse is strong and easily palpable and may be visible over superficial peripheral arteries. It’s characterized by regular, recurrent expansion and contraction of the arterial walls and isn’t obliterated by the pressure of palpation. A healthy person develops a bounding pulse during exercise, pregnancy, and periods of anxiety. However, this sign also results from fever and certain endocrine, hematologic, and cardiovascular disorders that increase the basal metabolic rate.

History

Ask the patient if he has noticed any weakness, fatigue, shortness of breath, or other health changes. Review his medical history for hyperthyroidism, anemia, or a cardiovascular disorder, and ask about his use of alcohol.

Physical assessment

If you detect a bounding pulse, check other vital signs and then auscultate the heart and lungs for any abnormal sounds, rates, or rhythms. Then complete your cardiovascular assessment.

Medical causes

Alcoholism (acute)

With acute alcoholism, vasodilation produces a rapid, bounding pulse and flushed face. An odor of alcohol on the breath and an ataxic gait are common. Other findings include hypothermia, bradypnea, labored and loud respirations, nausea, vomiting, diuresis, decreased level of consciousness, and seizures.

Anemia

With anemia, a bounding pulse may be accompanied by capillary pulsations, a systolic ejection murmur, tachycardia, an atrial gallop (S₄), a ventricular gallop (S₃), and a systolic bruit over the carotid artery. Other findings include fatigue, pallor, dyspnea and, possibly, bleeding tendencies.

Aortic insufficiency

Sometimes called a water-hammer pulse, bounding pulse associated with aortic insufficiency is characterized by rapid, forceful expansion of the arterial pulse followed by rapid contraction. Widened pulse pressure also occurs. Acute aortic insufficiency may produce findings associated with left-sided heart failure and cardiovascular collapse, such as weakness, severe dyspnea, hypotension, an S₃, and tachycardia. Additional findings include pallor, chest pain, palpitations, or strong, abrupt carotid pulsations. The patient may also experience pulsus bisferiens, an early systolic murmur, a murmur heard over the femoral artery during systole and diastole, and a high-pitched diastolic murmur that starts with the second heart sound. An apical diastolic rumble (Austin Flint murmur) may also occur, especially with heart failure. Most patients with chronic aortic insufficiency remain asymptomatic until their 40s or 50s, when exertional dyspnea, increased fatigue, orthopnea and, eventually, paroxysmal nocturnal dyspnea, angina, and syncope may develop.

Febrile disorder

Fever can cause a bounding pulse. Accompanying findings reflect the specific disorder but may include fatigue, chills, malaise, anorexia, tachycardia, tachypnea, and diaphoresis.

Thyrotoxicosis

Thyrotoxicosis produces a rapid, full, bounding pulse. Associated findings include tachycardia, palpitations, an S₃ or S₄ gallop, weight loss despite increased appetite, and heat intolerance. The patient may also develop diarrhea, an enlarged thyroid, dyspnea, tremors, nervousness, chest pain, exophthalmos, and signs of cardiovascular collapse. His skin will be warm, moist, and diaphoretic, and he may be hypersensitive to heat.

Special considerations

Prepare the patient for diagnostic laboratory and radiographic studies. If a bounding pulse is accompanied by rapid or irregular heartbeat, you may need to connect the patient to a cardiac monitor for further evaluation.

Pediatric pointers

A bounding pulse can be normal in infants or children because arteries lie close to the skin surface. It can also result from patent ductus arteriosus if the left-to-right shunt is large.

Patient counseling

Counsel the patient about dietary modifications, such as increasing consumption of iron-rich foods for the patient with anemia and reducing sodium intake for the patient with aortic insufficiency. Refer the patient who abuses alcohol to Alcoholics Anonymous (AA), and offer to arrange a visit from an AA member. Encourage frequent rest periods to reduce metabolic demands.

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Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Heart rhythm symptoms: Introduction (review 1482 causes)
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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Heart Murmurs (Asymptomatic) (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

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